Effect of epicardial fat and metabolic syndrome on reverse atrial remodeling after ablation for atrial fibrillation.
Effect of epicardial fat and metabolic syndrome on reverse atrial remodeling after ablation for atrial fibrillation.
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心外膜脂肪和代谢综合征对心房颤动消融后逆转心房重构的影响。
DOI：
10.1002/joa3.12124
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Hirayama A.
中科院分区：
文献类型：
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作者：
Monno K;Okumura Y;Saito Y;Aizawa Y;Nagashima K;Arai M;Watanabe R;Wakamatsu Y;Otsuka N;Yoda S;Hiro T;Watanabe I;Hirayama A.
背景代谢综合征/心外膜脂肪组织（EAT）在心房颤动（AF）中起重要作用。虽然反向心房重构（RAR）经常发生在AF消融后，EAT对RAR的影响仍然unknow.MethodsStudy受试者是104例患者，其中经胸超声心动图（TTE）进行AF消融前和3，6，12个月后。根据TTE胸骨旁视图中右心室前壁附近的厚度评估EAT。RAR被定义为左心房容积（LAV）指数减少>10%，3个月的随访examination.ResultsPostablation RAR发生在57/104（55%）的患者。RAR缺失与相对厚的EAT（4.92 ± 1.65 vs. 3.92 ± 1.17 mm，P=0.0005）、小的LAV指数（24.6 ± 7.5 vs. 28.8 ± 10.6 mL/m2，P=0.0233）和代谢综合征（62% vs. 28%，P =0.0006）相关。代谢综合征和EAT是RAR缺失的独立预测因子。厚EAT与消融后AF复发显著相关（5.05 ± 2.19 mm vs.无AF复发组4.17 ± 1.16 mm，P=0.0116），但与代谢综合征无关（48% vs. 42%，P =0.6189）。尽管体重没有变化，但无AF复发患者的EAT厚度在12个月时显著降低（4.17 ± 1.16 vs.3.65 ± 1.16mm，P<0.0001）。结论EAT和代谢综合征似乎与RAR缺失密切相关，但只有厚EAT与消融后AF复发显著相关。我们的研究结果，特别是EAT变薄，表明厚的EAT导致AF脆弱性，但EAT减少对消融结果有利。
BackgroundMetabolic syndrome/epicardial adipose tissue (EAT) plays an important role in atrial fibrillation (AF). Although reverse atrial remodeling (RAR) often occurs after AF ablation, the effects of EAT on RAR remain unknown.MethodsStudy subjects were 104 patients in whom transthoracic echocardiography (TTE) was performed before AF ablation and 3, 6, and 12 months afterward. EAT was assessed in terms of its thickness adjacent to the right ventricular anterior wall in the TTE parasternal view. RAR was defined as >10% reduction in the left atrial volume (LAV) index by the 3‐month follow‐up examination.ResultsPostablation RAR occurred in 57/104 (55%) patients. RAR absence was associated with a relatively thick EAT (4.92 ± 1.65 vs. 3.92 ± 1.17 mm,P=0.0005), small LAV index (24.6 ± 7.5 vs. 28.8 ± 10.6 mL/m2,P=0.0233), and metabolic syndrome (62% vs. 28%,P=0.0006). Metabolic syndrome and EAT were shown to be independent predictors of RAR absence. Thick EAT was significantly associated with AF recurrence after ablation (5.05 ± 2.19 mm vs. 4.17 ± 1.16 mm for no AF recurrence group,P=0.0116), but metabolic syndrome was not (48% vs. 42%,P=0.6189). Despite no change in body weight, EAT thickness decreased significantly by 12 months in patients without AF recurrence (4.17 ± 1.16 vs. 3.65 ± 1.16 mm,P<0.0001).ConclusionsEAT and metabolic syndrome appear to be strongly associated with RAR absence, but only the thick EAT was significantly associated with the postablation AF recurrence. Our findings, especially the thinning of EAT, suggest that thick EAT lead to AF vulnerability but that EAT reduction favorably affects ablation outcome.