Posterior Left Atrial Adipose Tissue Attenuation Assessed by Computed Tomography and Recurrence of Atrial Fibrillation After Catheter Ablation

Circulation Arrhythmia and Electrophysiology, vol. 14, pp. e009135

Abstract

Background: Atrial fibrillation (AF) recurrence following catheter ablation remains high. Recent studies have shown a relation between epicardial adipose tissue and AF. epicardial adipose tissue secretes several proinflammatory and anti-inflammatory adipokines that directly interact with the adjacent myocardium. The aim of the current study was to evaluate whether posterior left atrial (LA) adipose tissue attenuation, as marker of inflammation, is related to AF recurrences after catheter ablation. Methods: Consecutive patients with symptomatic AF referred for first AF catheter ablation who underwent computed tomography were included. The total epicardial adipose tissue and posterior LA adipose tissue were manually traced and adipose tissue was automatically recognized as tissue with Hounsfield units (HU) between −195 and −45. The attenuation value of the posterior LA adipose tissue was assessed, and the population was divided according to the mean HU value (−96.4 HU). Results: In total, 460 patients (66% male, age 61±10 years) were included in the analysis. After a median follow-up of 18 months (interquartile range, 6–32), 168 (37%) patients had AF recurrence. Patients with higher attenuation (≥−96.4 HU) of the posterior LA adipose tissue showed higher AF recurrence rates compared with patients with lower attenuation (<−96.4 HU; log-rank test P =0.046). Univariate analysis showed an association between AF recurrence and higher posterior LA adipose tissue attenuation (≥−96.4 HU; P <0.05). On multivariable analysis, posterior LA adipose tissue attenuation (hazard ratio, 1.26 [95% CI, 0.90–1.76]; P =0.181) remained a promising predictor of AF recurrence following catheter ablation. Conclusions: Posterior LA adipose tissue attenuation is a promising predictor of AF recurrence in patients who undergo catheter ablation. Higher adipose tissue attenuation might signal increased local inflammation and serve as an imaging biomarker of increased risk of AF recurrence. Graphic Abstract: A graphic abstract is available for this article.

Authors 15

1. Mohammed El Mahdiui Aachen Department of Cardiology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands

   Mohammed El Mahdiui https://orcid.org/0000-0002-7566-7657 Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands

2. Judit Simon

   Semmelweis University

   Affiliation as printed

   MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary

   Judit Simon https://orcid.org/0000-0001-8063-3462 MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary

3. Jeff M. Smit Aachen Department of Cardiology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands

   Jeff M. Smit Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands

4. Jurriën H. Kuneman Aachen Department of Cardiology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands

   Jurrien H. Kuneman https://orcid.org/0000-0003-2162-2768 Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands

5. Alexander R. van Rosendael Aachen Department of Cardiology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands

   Alexander R. van Rosendael Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands

6. Ewout Willem Steyerberg Aachen Department of Biomedical Data Sciences Ewout W. Steyerberg Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences (E.W.S.), Leiden University Medical Center, the Netherlands

   Ewout W. Steyerberg Department of Biomedical Data Sciences (E.W.S.), Leiden University Medical Center, the Netherlands

7. Rob J. van der Geest Aachen Division of Image Processing (LKEB)

   Leiden University Medical Center

   Affiliation as printed

   Division of Image Processing (R.J.v.d.G.), Leiden University Medical Center, the Netherlands

   Rob J. van der Geest https://orcid.org/0000-0002-9084-5597 Division of Image Processing (R.J.v.d.G.), Leiden University Medical Center, the Netherlands

8. Lili Száraz

   Semmelweis University

   Affiliation as printed

   MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary

9. Szilvia Herczeg

   Semmelweis University

   Affiliation as printed

   MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary

   Szilvia Herczeg https://orcid.org/0000-0002-0211-0399 MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary

10. Nándor Szegedi

    Semmelweis University

    Affiliation as printed

    MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary

11. László Gellér

    Semmelweis University

    Affiliation as printed

    MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary

12. Victoria Delgado Aachen Department of Cardiology, Leiden University Medical Centre

    Leiden University · Leiden University Medical Center

    Affiliation as printed

    Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands

    Victoria Delgado https://orcid.org/0000-0002-9841-2737 Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands

13. Béla Péter Merkely

    Semmelweis University

    Affiliation as printed

    MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary

    Bela Merkely https://orcid.org/0000-0001-6514-0723 MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary

14. Jeroen Joost Bax Aachen Department of Cardiology, Leiden University Medical Centre

    Leiden University · Leiden University Medical Center

    Affiliation as printed

    Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands

    Jeroen J. Bax Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands

15. Pál Maurovich‐Horvat

    Semmelweis University

    Affiliation as printed

    Department of Radiology, Medical Imaging Centre (P.M.-H.), Semmelweis University, Budapest, Hungary

    MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary