Postoperative atrial fibrillation and atrial epicardial fat: Is there a link?

• Published in: International journal of cardiology. Heart & vasculature Vol. 39; p. 100976
• Main Authors: van der Heijden, Claudia A.J., Verheule, Sander, Olsthoorn, Jules R., Mihl, Casper, Poulina, Lexan, van Kuijk, Sander M.J., Heuts, Samuel, Maessen, Jos G., Bidar, Elham, Maesen, Bart
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-04-2022; Elsevier
• Subjects: Cardiac surgery; Computed tomography scan; Epicardial adipose tissue; Original Paper; Postoperative atrial fibrillation; POAF; Computed tomography scan; LVEF; MYO-V; Postoperative atrial fibrillation; Cardiac surgery; kV; LAVI; HU; Epicardial adipose tissue; BSA; CCTA; BMI; ml; SR; MYO; AF; CM; EAT-V; ROI; CT; AV; LA; EAT; CABG; LAVI, LA Volume Index; AV, Aortic Valve; SR, Sinus Rhythm; MYO-V, MYO-Volume; CCTA, Coronary Computed Tomographic Angiography; AF, Atrial Fibrillation; CABG, Coronary Artery Bypass Graft; BMI, Body Mass Index; kV, Kilovoltage; CM, Contrast Management; EAT-V, EAT-Volume; LA, Left Atrial; MYO, Myocardial; BSA, Body Surface Area; EAT, Epicardial Adipose Tissue; LVEF, Left Ventricular Ejection Fraction; ROI, Regions Of Interest; CT, Computed Tomography; HU, Hounsfield Units; POAF, Post-Operative AF; ml, Millilitre
• ISSN: 2352-9067; 2352-9067
• DOI: 10.1016/j.ijcha.2022.100976

•Detailed local EAT analysis does not differ between POAF and non-POAF.•General rather than local effects of EAT play a role in the onset of early POAF.•The dominance of surgical induced factors may obscure the potential role of EAT.
Atrial Epicardial Adipose Tissue (EAT) is presumably involved in the pathogenesis of atrial fibrillation (AF). The transient nature of postoperative AF (POAF) suggests that surgery-induced triggers provoke an unmasking of a pre-existent AF substrate. The aim is to investigate the association between the volume of EAT and the occurrence of POAF. We hypothesise that the likelihood of developing POAF is higher in patients with high compared to low left atrial (LA) EAT volumes.
Quantification of LA EAT based on the Hounsfield Units using custom made software was performed on pre-operative coronary computed tomography angiography scans of patients who underwent cardiac surgery between 2009 and 2019. Patients with mitral valve disease were excluded.
A total of 83 patients were included in this study (CABG = 34, aortic valve = 33, aorta ascendens n = 7, combination n = 9), of which 43 patients developed POAF. The EAT percentage in the LA wall nor indexed EAT volumes differed between patients with POAF and with sinus rhythm (all P > 0.05). In multivariable analysis, age and LA volume index (LAVI) were the only independent predictors for early POAF (OR: 1.076 and 1.056, respectively).
As expected, advanced age and LAVI were independent predictors of POAF. However, the amount of local EAT was not associated with the occurrence of AF after cardiac surgery. This suggests that the role of EAT in POAF is rather limited, or that the association of EAT in the early phase of POAF is obscured by the dominance of surgical-induced triggers.