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32. Cardiovascular Nursing
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Epicardial Adipose Tissue And Atrial Fibrillation: Guilty As Charged Or Guilty By Association?
Session:
Painel 5 -Arritmologia 2
Speaker:
Joao Adriano Sousa
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.1 Atrial Fibrillation - Pathophysiology and Mechanisms
Session Type:
Posters
FP Number:
---
Authors:
Joao Adriano Sousa; Daniel Nascimento Matos; António Ferreira; João Abecasis; Carla Matias; Pedro Freitas; João Carmo; Maria Salomé Carvalho; Gustavo Da Rocha Rodrigues; Anai Durazzo; Francisco Moscoso Costa; Pedro Lopes Do Carmo; Francisco Bello Morgado; Diogo Cavaco; Pedro Adragão
Abstract
<p><strong>Background:</strong> Epicardial adipose tissue (EAT) has been linked to the presence and burden of atrial fibrillation (AF). However, it is still unclear whether this relationship is causal or simply a surrogate marker of other risk factors commonly associated with AF.</p> <p><strong>Objective:</strong> The purpose of this study was to assess the relationship between these factors and EAT, and to compare their performance in predicting AF recurrence after an ablation procedure.</p> <p><strong>Methods:</strong> We assessed 575 consecutive patients (mean age 61±11 years, 62% male) undergoing AF ablation preceded by cardiac CT in a high-volume ablation center. EAT was measured on cardiac CT using a modified simplified method. Patients were divided into 2 groups (above vs below the median EAT volume). Cox regression was used to assess the relationship between epicardial fat, risk factors, and AF relapse.</p> <p><strong>Results:</strong> Patients with above-median EAT volume were <strong>older </strong>(p<0.001), more often <strong>male </strong>(OR 1.7, p=0.002), had <strong>higher body mass index </strong>(p<0.001), and higher prevalence of <strong>smoking </strong>(OR 1.8, p=0.002), <strong>hypertension </strong>(OR 2.2, p<0.001), <strong>diabetes </strong>(OR 2.0, p=0.01)and <strong>dyslipidemia </strong>(OR 1.8, p<0.001). Non-paroxysmal forms of AF were also more commonly found in those with above-median EAT volume. During a median follow-up of 18 months, 232 patients (40.3%) suffered AF recurrence. After adjustment for BMI and other univariate predictors of relapse, three variables emerged independently associated with time to AF recurrence: <u>non-paroxysmal AF</u> (HR 2.1, 95%CI: 1.5-2.7, p<0.001), <u>indexed left atrial (LA) volume</u> (HR 1.006, 95%CI: 1.002-1.011, p<0.001), and <u>indexed epicardial fat volume</u> (HR 1.87, 95%CI: 1.66-2.1, p<0.001). None of the classic cardiovascular risk factors were an independent predictor of AF recurrence over time (all p>0.10).</p> <p><strong>Conclusion:</strong> Classic cardiovascular risk factors are more prevalent in patients with higher amounts of epicardial fat. However, unlike these risk factors, EAT is a powerful predictor of AF recurrence after ablation. These findings suggest that EAT is not merely a surrogate marker, but an important participant in the pathophysiology of AF.</p>
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