Periatrial Fat Quality Predicts Atrial Fibrillation Ablation Outcome

Luisa Ciuffo, Hieu Nguyen, Mateus Diniz Marques, Konstantinos N. Aronis, Bhradeev Sivasambu, Henrique D. de Vasconcelos, Susumu Tao, David D. Spragg, Joseph E. Marine, Ronald D. Berger, Joao A.C. Lima, Hugh Calkins, Hiroshi Ashikaga

Research output: Contribution to journalArticlepeer-review


Background Previous studies showed that the quantity of the left atrial (LA) periatrial fat tissue predicts recurrence after catheter ablation of atrial fibrillation (AF). We hypothesized that the quality of the LA periatrial fat tissue, measured by the mean computed tomography attenuation, predicts recurrence after AF ablation independent of the quantity of the LA periatrial fat tissue. Methods We included 143 consecutive patients with drug-refractory AF referred for the first catheter ablation of AF (62.2±10 years, 40% nonparoxysmal AF). All participants had a preablation cardiac computed tomography. We measured the quantity of the LA periatrial fat tissue by the area (millimeter square) and the quality by the mean computed tomography attenuation (Hounsfield units) in a standard 4-chamber view. Results Patients with AF recurrence after ablation (n=57) had a significantly larger fat area (167.6 [interquartile range, 124.1-255] versus 145.4 [95.6-229.3] mm2; P=0.018) and a higher fat attenuation (-92.0±9.8 versus -96.5±9.4 Hounsfield units; P=0.006) than those without recurrence (controls). LA fat attenuation was correlated with LA fat volume and LA bipolar voltage by invasive mapping and was associated with AF recurrence after adjusting for clinical risk factors, including body mass index, AF type, LA dimension, and fat area (hazard ratio, 2.65; P=0.001). Conclusions The quality of the LA periatrial fat tissue is an independent predictor of recurrence after the first AF ablation. Assessment of LA periatrial fat attenuation can improve AF ablation outcomes by refining patient selection.

Original languageEnglish (US)
Pages (from-to)e008764
JournalCirculation. Cardiovascular imaging
Issue number6
StatePublished - Jun 1 2019


  • atrial fibrillation
  • body mass index
  • catheter ablation
  • patient selection
  • risk factors

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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