Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands.
Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
Eur J Cardiothorac Surg. 2019 Jul 1;56(1):79-86. doi: 10.1093/ejcts/ezy472.
Epicardial adipose tissue volume (EAT-V) has been linked to atrial fibrillation (AF) recurrences after catheter ablation. We retrospectively studied the association between atrial EAT-V and outcome after hybrid AF ablation (epicardial surgical and endocardial catheter ablation).
On preoperative cardiac computed tomography angiography scans, the left atrium and right atrium were manually delineated using the open source ImageJ. With custom-made automated software, the number of pixels in the regions of interest on each slice was calculated. On the basis of the Hounsfield units, pixel size and slice thickness, EAT-V was computed and normalized in relation to the body surface area (BSA) and the myocardial tissue volume.
Eighty-five patients were included. Left atrial and right atrial EAT-V normalized to BSA were not significantly different between paroxysmal and persistent AF [0.84 (0.51-1.50) vs 0.81 (0.57-1.18), 1.74 (1.02-2.56) vs 1.55 (1.26-2.18), all P = 0.9], neither between the acute conduction block and no acute conduction block in the epicardial box lesion [0.92 (0.55-1.39) vs 0.72 (0.55-1.24), P = 0.5, right atrium not applicable], nor between the sinus rhythm and arrhythmia recurrence after 12 months [0.88 (0.55-1.48) vs 0.63 (0.47-1.10), 1.61 (1.11-2.50) vs 1.55 (1.20-2.20), all P > 0.1]. Left atrial EAT-V normalized to myocardial tissue volume was not different between the groups.
This study could neither confirm that EAT-V was predictive of recurrence of supraventricular arrhythmias in patients undergoing a hybrid AF ablation, nor that EAT-V was different between patients with paroxysmal AF and persistent and long-standing persistent AF. This suggests that EAT-V might not affect the outcome in surgical ablation procedures and therefore should not influence preoperative or intraoperative decision-making.
心外膜脂肪组织体积（EAT-V）与导管消融术后心房颤动（AF）复发有关。我们回顾性研究了左心房 EAT-V 与杂交 AF 消融（心外膜手术和心内膜导管消融）后结果之间的关系。
在术前心脏 CT 血管造影扫描中，使用开源 ImageJ 手动描绘左心房和右心房。使用定制的自动化软件，计算每个切片上感兴趣区域的像素数。根据亨氏单位、像素大小和切片厚度，计算并归一化 EAT-V 与体表面积（BSA）和心肌组织体积的关系。
共纳入 85 例患者。阵发性和持续性 AF 之间左心房和右心房 EAT-V 与 BSA 归一化值无显著差异[0.84（0.51-1.50）比 0.81（0.57-1.18），1.74（1.02-2.56）比 1.55（1.26-2.18），均 P=0.9]，心外膜盒病变的急性传导阻滞与无急性传导阻滞之间也无差异[0.92（0.55-1.39）比 0.72（0.55-1.24），P=0.5，右心房不适用]，窦性节律与 12 个月后心律失常复发之间也无差异[0.88（0.55-1.48）比 0.63（0.47-1.10），1.61（1.11-2.50）比 1.55（1.20-2.20），均 P＞0.1]。左心房 EAT-V 与心肌组织体积的归一化值在各组之间无差异。
本研究既不能证实 EAT-V 可预测接受杂交 AF 消融术的患者的室上性心律失常复发，也不能证实阵发性 AF 与持续性和长期持续性 AF 患者之间的 EAT-V 不同。这表明 EAT-V 可能不会影响手术消融术的结果，因此不应影响术前或术中的决策。
