Anagnostopoulos Ioannis, Kousta Maria, Kossyvakis Charalampos, Paraskevaidis Nikolaos Taxiarchis, Vrachatis Dimitrios, Deftereos Spyridon, Giannopoulos Georgios
Cardiology Department, Athens General Hospital "G. Gennimatas", 11527 Athens, Greece.
2nd Department of Cardiology, National and Kapodistrian University of Athens, 15772 Athens, Greece.
J Clin Med. 2023 Oct 5;12(19):6369. doi: 10.3390/jcm12196369.
(1)Introduction: Catheter ablation has become a cornerstone for the management of patients with atrial fibrillation (AF). Nevertheless, recurrence rates remain high. Epicardial adipose tissue (EAT) has been associated with AF pathogenesis and maintenance. However, the literature has provided equivocal results regarding the relationship between EAT and post-ablation recurrence.(2) Purpose: to investigate the relationship between total and peri-left atrium (peri-LA) EAT with post-ablation AF recurrence. (3) Methods: major electronic databases were searched for articles assessing the relationship between EAT, quantified using computed tomography, and the recurrence of AF following catheter ablation procedures. (4) Results: Twelve studies (2179 patients) assessed total EAT and another twelve (2879 patients) peri-LA EAT. Almost 60% of the included patients had paroxysmal AF and recurrence was documented in 34%. Those who maintained sinus rhythm had a significantly lower volume of peri-LA EAT (SMD: -0.37, 95%; CI: -0.58-0.16, I2: 68%). On the contrary, no significant difference was documented for total EAT (SMD: -0.32, 95%; CI: -0.65-0.01; I2: 92%). No differences were revealed between radiofrequency and cryoenergy pulmonary venous isolation. No publication bias was identified. (5) Conclusions: Only peri-LA EAT seems to be predictive of post-ablation AF recurrence. These findings may reflect different pathophysiological roles of EAT depending on its location. Whether peri-LA EAT can be used as a predictor and target to prevent recurrence is a matter of further research.
(1) 引言：导管消融已成为心房颤动（AF）患者治疗的基石。然而，复发率仍然很高。心外膜脂肪组织（EAT）与房颤的发病机制及维持有关。然而，关于EAT与消融后复发之间的关系，文献给出的结果并不明确。(2) 目的：研究总EAT和左心房周围（peri-LA）EAT与消融后房颤复发之间的关系。(3) 方法：检索主要电子数据库，查找评估使用计算机断层扫描定量的EAT与导管消融术后房颤复发之间关系的文章。(4) 结果：12项研究（2179例患者）评估了总EAT，另有12项研究（2879例患者）评估了左心房周围EAT。纳入患者中近60%患有阵发性房颤，34%记录有复发。维持窦性心律的患者左心房周围EAT体积显著更低（标准化均数差：-0.37，95%；可信区间：-0.58 - 0.16，I²：68%）。相反，总EAT未记录到显著差异（标准化均数差：-0.32，95%；可信区间：-0.65 - 0.01；I²：92%）。射频和冷冻能量肺静脉隔离之间未发现差异。未发现发表偏倚。(5) 结论：似乎只有左心房周围EAT可预测消融后房颤复发。这些发现可能反映了EAT因其位置不同而具有不同的病理生理作用。左心房周围EAT是否可作为预测指标和预防复发的靶点有待进一步研究。
