scholarly journals Epicardial obesity and atrial fibrillation: emphasis on atrial fat depot

2020 ◽  
Vol 17 (3) ◽  
pp. 316-325
Author(s):  
Evgeniy S. Mazur ◽  
Vera V. Mazur ◽  
Nikolay D. Bazhenov ◽  
Sergey V. Kolbasnicov ◽  
Oksana V. Nilova
Keyword(s):  
Atrial Fibrillation ◽  
Transesophageal Echocardiography ◽  
Strong Predictor ◽  
Interatrial Septum ◽  
Epicardial Fat ◽  
Thromboembolic Complications ◽  
Thromboembolic Stroke ◽  
Lateral Ridge ◽  
Fat Depot ◽  
The Relationship

The studies, performed with MRI and CT, showed that the increase of fat, immediately adjacent to the myocardium (epicardial fat) is correlated more strongly with the risk of atrial fibrillation than the general or abdominal obesity. According to some studies, epicardial fat around the left atrium is a strong predictor of the development at atrial fibrillation. Also, the amount of the fat is associated with the effectiveness of cardioversion and the risk of developing thromboembolic stroke in patients with atrial fibrillation. The number of such works is small, since tomographic examinations are not needed if intra-atrial thrombosis is suspected, and transthoracic echocardiograthy does not allow visualization of atrial fat. However, transesophageal echocardiography is widely used in patients with atrial fibrillation and allows to measure the structures that serve as depots of epicardial fat, namely the interatrial septum and left lateral ridge. Accumulation of epicardial fat leads to thickening of these structures. This can be used to study the relationship between epicardial obesity and the risk of thromboembolic complications in patients with atrial fibrillations.

scholarly journals Is epicardial fat depot associated with atrial fibrillation? A systematic review and meta-analysis

EP Europace ◽  
2017 ◽  
Vol 19 (5) ◽  
pp. 747-752 ◽  
Author(s):  
Maddalena Gaeta ◽  
Francesco Bandera ◽  
Federico Tassinari ◽  
Lorenzo Capasso ◽  
Miriam Cargnelutti ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Meta Analysis ◽  
Epicardial Fat ◽  
Fat Depot

scholarly journals Epicardial adipose tissue and atrial fibrillation: guilty as charged or guilty by association?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Sousa ◽  
D Matos ◽  
A Ferreira ◽  
J Abecasis ◽  
C Saraiva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Cardiovascular Risk ◽  
Cardiac Ct ◽  
Epicardial Adipose Tissue ◽  
Surrogate Marker ◽  
Epicardial Fat ◽  
The Relationship ◽  
Af Recurrence

Abstract Background 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. Purpose 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. Methods 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. Results Patients with above-median EAT volume were older (p<0.001), more often male (OR 1.7, p=0.002), had higher body mass index, and higher prevalence of smoking, hypertension, diabetes and dyslipidemia (p<0.05). Non-paroxysmal AF was also more common 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: non-paroxysmal AF (HR 2.1, 95% CI: 1.5–2.7, p<0.001), indexed left atrial (LA) volume (HR 1.006 per mL/m2, 95% CI: 1.002–1.011, p<0.001), and indexed epicardial fat volume (HR 1.87 per mL/m2, 95% CI: 1.66–2.1, p<0.001). None of the classic cardiovascular risk factors were an independent predictor of AF recurrence (all p>0.10). Conclusion 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. EAT, cvrf and AF burden Funding Acknowledgement Type of funding source: None

Stroke Prevention in Atrial Fibrillation – The Unmet Need and Morbidity Burden

2011 ◽  
Vol 7 (3) ◽  
pp. 187 ◽  
Author(s):  
A John Camm ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Unmet Need ◽  
Left Ventricular ◽  
Risk Category ◽  
Intermediate Risk ◽  
Thromboembolic Complications ◽  
Thromboembolic Stroke ◽  
Age Related

Atrial fibrillation (AF) occurs in epidemic proportion and is now recognised to occur in about 2 % of the general population. Its prevalence is age-related – about 10 % of 80-year-olds have this arrhythmia with hypertension, valvular disease and heart failure being the most frequent underlying conditions. Up to 10 % of cases of AF may be idiopathic, although genetic, autonomic, inflammatory, infective and toxic causes may account for many of these. AF is associated with serious consequences of which death, sudden death, stroke, heart failure, pulmonary disease and hospitalisation are the most serious. Thromboembolic stroke occurs in about 5 % of AF patients each year, which is approximately five-fold the stroke rate in age and gender-matched patients without AF. AF-related thromboembolic stroke accounts for 15–20 % of all strokes. Risk factors for thromboembolic stroke include clinical factors (such as age, female gender, diabetes, heart failure, hypertension, renal failure and arterial disease), elevated levels of biomarkers (such as troponin, B-type natriuretic peptide, C-reactive protein and micro-albuminuria) and echocardiographic features (such as left ventricular systolic dysfunction, increased left atrial size, left atrial ‘smoke’ and thrombus). There are several clinical risk stratification schemes used to identify AF patients at high risk of thromboembolic stroke. The CHADS2 scheme is popular, but tends to group a high proportion of patients in low and intermediate risk categories. The recently introduced CHA2DS2-VASc scheme identifies truly low-risk patients and avoids placing more than a small proportion in a low or intermediate risk category where there is a guideline mandated choice between anticoagulant, antiplatelet or no therapy. This scheme, which is well validated, has been recommended by the European Society of Cardiology in anticipation of the introduction of new and safer oral anticoagulants. Although warfarin is an effective therapy for the prevention of thromboembolic complications of AF it is inadequately used because of fear of haemorrhagic complications and the difficulties associated with monitoring and maintenance of the correct level of anticoagulation. At present, as few as 20 % of patients who should be anticoagulated are effectively treated. New anticoagulant therapies, which are much easier to use, coupled with more attention to the indications for anticoagulation, should result in more effective anticoagulation and a major reduction in the thromboembolic complications associated with AF.

Sign in / Sign up

Export Citation Format

Share Document