J Korean Soc Radiol.  2019 Sep;80(5):930-941. 10.3348/jksr.2019.80.5.930.

Relationship between Epicardial Fat Accumulation and Left Atrial Reverse Remodeling after Catheter Ablation of Atrial Fibrillation

• Lee JY
• Oh YW
• Kim YH
• Shim J
• Hwang SH

• KMID: 2459018
• DOI: http://doi.org/10.3348/jksr.2019.80.5.930

Abstract

PURPOSE
To demonstrate the relationship between epicardial fat accumulation and left atrial reverse remodeling by cardiac multi-detector CT (MDCT) after catheter ablation of atrial fibrillation (AF).
MATERIALS AND METHODS
Seventy-six patients underwent cardiac MDCT before and after catheter ablation of AF. Left atrial volume (LAV) and epicardial fat volume (EFV) were measured. LAV and EFV before and after catheter ablation of AF were respectively compared and the change percentages (CPs) were evaluated.
RESULTS
The LAV after catheter ablation of AF was significantly less than the baseline LAV (107.5 ± 50.2 mL vs. 144.9 ± 62.6 mL, p < 0.001). The EFV after catheter ablation of AF was significantly greater than the baseline EFV (105.0 ± 35.6 mL vs. 90.1 ± 31.9 mL, p < 0.001). Mean CPs of LAV and EFV were −23.3% ± 20.8% and 15.9% ± 20.9%, respectively. There was a significantly negative relationship between the CPs of LAV and EFV (R = −0.53, p < 0.001).
CONCLUSION
Catheter ablation of AF may result in a reduction in LAV and an increase in EFV. Left atrial reverse remodeling with a reduction in LAV may be associated with epicardial fat accumulation in patients who undergo catheter ablation of AF.

MeSH Terms

Atrial Fibrillation*
Catheter Ablation*
Catheters*
Heart Atria
Humans
Multidetector Computed Tomography

Figure

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  Fig. 1 Schematic protocol for selection of the study population. AF = atrial fibrillation

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  Fig. 2 Measurement of LAV, EFV, and EST using 3D cardiac CT data. A. LAV measurement. Contrast-enhanced left atrial cavity (green) on the cardiac CT image allows total LAV measurement based on a 3D volume-rendering image of the left atrium. B. EFV measurement. Pixels (green) of fat density (−190 to −30 Hounsfield units) within the epicardial space on cardiac CT image allow EFV measurement based on the 3D volume-rendering image of total epicardial fat. C. EST measurement. In the measurement of EST, a four-chamber view of cardiac CT images shows the maximum distances at the EST between the myocardial surface and pericardium at interatrial groove (blue arrow) and atrioventricular groove (red arrow). 3D = three-dimensional, AV = atrioventricular groove, EFV = epicardial fat volume, EST = epicardial space thickness, IS = interatrial septal groove, LAV = left atrial volum

• 

  Fig. 3 Changes in LAV and EFV determined with cardiac CT images after catheter ablation of AF. A. Left atrial chamber (green) on cardiac CT images shows a decrease in size after catheter ablation of AF. Using a 3D volume-rendering image of the left atrium from cardiac CT data, the baseline LAV was determined to be 115.0 mL. After AF ablation, LAV changed to 83.3 mL. B. Cardiac CT images show prominent epicardial spaces (red arrows) after catheter ablation of AF. Using a 3D volume-rendering image of epicardial fat from cardiac CT data, the baseline EFV was determined to be 88.0 mL. After catheter ablation of AF, EFV changed to 132.0 mL. 3D = three-dimensional, AF = atrial fibrillation, EFV = epicardial fat volume, LAV = left atrial volume

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  Fig. 4 Comparison of the multi-detector CT measurements obtained before and after catheter ablation of AF. A. The lines represent the trajectory of LAV for each patient. There is a significant difference in mean LAV before and after catheter ablation of AF. B. The lines represent the trajectory of EFV for each patient. There is a significant difference in mean EFV before and after catheter ablation of AF. AF = atrial fibrillation, EFV = epicardial fat volume, LAV = left atrial volume

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  Fig. 5 Relationship between the change percentages of EFV and LAV after catheter ablation of atrial fibrillation. EFV = epicardial fat volume, LAV = left atrial volume

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