Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Dec;94(1128):20210361.
doi: 10.1259/bjr.20210361. Epub 2021 Sep 14.

Association between pericoronary adipose tissue attenuation and outcome after second-generation cryoballoon ablation for atrial fibrillation

Kai Nogami  1 , Tomoyo Sugiyama  1 , Yoshihisa Kanaji  1 , Masahiro Hoshino  1 , Satoshi Hara  1 , Masao Yamaguchi  1 , Masahiro Hada  1 , Yohei Sumino  1 , Toru Misawa  1 , Hidenori Hirano  1 , Hiroki Ueno  1 , Naoyuki Miwa  1 , Kazuya Yamao  1 , Shigeki Kusa  1 , Hitoshi Hachiya  1 , Tsunekazu Kakuta  1
Affiliations
Observational Study

Association between pericoronary adipose tissue attenuation and outcome after second-generation cryoballoon ablation for atrial fibrillation

Kai Nogami et al. Br J Radiol. 2021 Dec.

Abstract

Objectives: Previous studies reported the association between inflammation and atrial fibrillation (AF). Pericoronary adipose tissue (PCAT) attenuation, PCATA, on cardiac CT angiography (CTA) reflects pericoronary inflammation. We hypothesized that the PCATA predicts AF recurrence after cryoballoon ablation (CBA) for paroxysmal and persistent AF.

Methods: We studied 364 patients (median age, 65 years) with persistent (n = 41) and paroxysmal (n = 323) AF undergoing successful first-session second-generation CBA with pre-ablation cardiac CTA. Three-vessel (3V)-PCATA was defined as the mean CT attenuation value of PCAT of all three major coronary arteries. Predictors of AF recurrence during follow-up were evaluated.

Results: AF recurrence after the 3-month blanking period was detected in 90 patients (24.7%) during the median follow-up of 26 (interquartile range, 19-42) months. AF recurrence was associated with prior stroke and statin use, NT-proBNP and high-sensitivity cardiac troponin-I levels, left ventricular dimension, left atrial volume index (LAVI), 3V-PCATA, and early AF recurrence during the blanking period. On multivariable Cox proportional hazard analysis, prior stroke (hazard ratio [HR], 2.208, 95% confidence interval [CI], 1.166-4.180, p = 0.015), LAVI (HR, 1.030, 95% CI, 1.010-1.051, p = 0.003), 3V-PCATA (HR, 1.034, 95% CI, 1.001-1.069, p = 0.046), and early AF recurrence (HR, 2.858, 95% CI, 1.855-4.405, p < 0.001) remained statistically significant.

Conclusion: Pre-ablation CTA-derived 3V-PCATA, representing pericoronary inflammation, was an independent predictor of recurrence after first-session AF ablation using a second-generation cryoballoon.

Advances in knowledge: Assessment of 3V-PCATA may identify patients at high risk of AF recurrence after CBA for AF.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Study flow diagram.
Figure 2.
Figure 2.
Representative computed tomography angiography images of a patient with paroxysmal atrial fibrillation who experienced atrial fibrillation recurrence 231 days after ablation. (A) Three-dimensional reconstruction of the heart. (B) Three-dimensional reconstruction of the left atrium and pulmonary veins. (C) Curved planar reformation view showed no epicardial stenosis in the left anterior descending artery (LAD). Pericoronary adipose tissue (PCAT) at the proximal 40 mm segment was traced. (D) Cross-sectional view showing the color map of computed tomography (CT) attenuation of PCAT (PCATA). (E) Histogram of CT attenuation indicated that the PCATA value in the LAD was −62.03 Hounsfield units (HU). In the same manner, the PCATA values in the left circumflex artery and right coronary artery were −53.41 HU and −64.85 HU, respectively. The three-vessel-PCATA value was −60.09 HU. The left atrial volume index on echocardiography was 44.9 mL m−2.
Figure 3.
Figure 3.
Pre-ablation three-vessel pericoronary adipose tissue attenuation (3V-PCATA) value and its distribution.
Figure 4.
Figure 4.
The prevalence of atrial fibrillation (AF) recurrence stratified according to these two best cut-off values of left atrial volume index (LAVI) and three-vessel pericoronary adipose tissue attenuation (3V-PCATA).
Figure 5.
Figure 5.
Kaplan–Meier analysis for the incidence of atrial fibrillation recurrence. LAVI, left atrial volume index; 3V-PCATA, three-vessel pericoronary adipose tissue attenuation.
See this image and copyright information in PMC

References

    1. Hu Y-F, Chen Y-J, Lin Y-J, Chen S-A. Inflammation and the pathogenesis of atrial fibrillation. Nat Rev Cardiol 2015; 12: 230–43. doi: 10.1038/nrcardio.2015.2 - DOI - PubMed
    1. Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH. Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circ Res 2017; 120: 1501–17. doi: 10.1161/CIRCRESAHA.117.309732 - DOI - PMC - PubMed
    1. Calkins H, Hindricks G, Cappato R, Kim Y-H, Saad EB, Aguinaga L, et al. . 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14: e275–444. doi: 10.1016/j.hrthm.2017.05.012 - DOI - PMC - PubMed
    1. Kuck K-H, Brugada J, Fürnkranz A, Metzner A, Ouyang F, Chun KRJ, et al. . Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med 2016; 374: 2235–45. doi: 10.1056/NEJMoa1602014 - DOI - PubMed
    1. Wong CX, Abed HS, Molaee P, Nelson AJ, Brooks AG, Sharma G, et al. . Pericardial fat is associated with atrial fibrillation severity and ablation outcome. J Am Coll Cardiol 2011; 57: 1745–51. doi: 10.1016/j.jacc.2010.11.045 - DOI - PubMed

Publication types