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      Is epicardial fat tissue associated with atrial fibrillation recurrence after ablation? A systematic review and meta-analysis

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          Abstract

          Introduction

          Although an undoubted association between epicardial fat tissue (EFT) and atrial fibrillation (AF) has been recently approved, the association between EFT and post-ablation AF recurrence is not evident yet. This study aimed to assess the association between EFT and AF recurrence after ablation.

          Methods

          The present study was a systematic review and meta-analysis using related literature available in electronic databases until July 2018 via “atrial fibrillation” and “epicardial fat” as the main keywords. Considering the different methods of EFT measurement, three different pooled meta-analyses were conducted in this study including: 1) comparison of total EFT volume, 2) left atrium (LA)-EFT volume, and 3) EFT thickness between two groups with and without AF recurrence estimating standardized mean difference (SMD) through a random and non-random effect meta-analysis. Statistical analysis was also performed using Comprehensive Meta-analysis (CMA) Software.

          Results

          Following a search into a total number of 518 articles, the findings of 12 studies published in 10 articles were enrolled in this meta-analysis. Accordingly, the results of meta-analysis showed that LA-EFT and total EFT volumes were higher in recurrent subjects (LA-EFT: SMD = 0.862 ml; I 2 = 0.00, 95% confidence interval (CI) = 0.567–1.156; total EFT: SMD = 1.017 ml, I 2 = 0.00, 95% CI = 0.748–1.286). Besides, a significant higher EFT thickness in patients with AF recurrence compared to those with no AF recurrence was observed (SMD = 0.808 mm, I 2 = 91.07, 95% CI = 0.215–1401).

          Conclusion

          The total EFT and LA-EFT volumes, as well as EFT thickness, seemed to be associated with AF recurrence in patients undergoing AF ablation.

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          Most cited references32

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          Epicardial fat and atrial fibrillation: current evidence, potential mechanisms, clinical implications, and future directions

          Obesity is increasingly recognized as a major modifiable determinant of atrial fibrillation (AF). Although body mass index and other clinical measures are useful indications of general adiposity, much recent interest has focused on epicardial fat, a distinct adipose tissue depot that can be readily assessed using non-invasive imaging techniques. A growing body of data from epidemiological and clinical studies has demonstrated that epicardial fat is consistently associated with the presence, severity, and recurrence of AF across a range of clinical settings. Evidence from basic science and translational studies has also suggested that arrhythmogenic mechanisms may involve adipocyte infiltration, pro-fibrotic, and pro-inflammatory paracrine effects, oxidative stress, and other pathways. Despite these advances, however, significant uncertainty exists and many questions remain unanswered. In this article, we review our present understanding of epicardial fat, including its classification and quantification, existing evidence implicating its role in AF, potential mechanisms, implications for clinicians, and future directions for research.
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            Effect of intensive versus moderate lipid-lowering therapy on epicardial adipose tissue in hyperlipidemic post-menopausal women: a substudy of the BELLES trial (Beyond Endorsed Lipid Lowering with EBT Scanning).

            This study sought to evaluate the effect of intensive and moderate statin therapy on epicardial adipose tissue (EAT).
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              Cardiac adipose tissue and atrial fibrillation: the perils of adiposity.

              The amount of adipose tissue that accumulates around the atria is associated with the risk, persistence, and severity of atrial fibrillation (AF). A strong body of clinical and experimental evidence indicates that this relationship is not an epiphenomenon but is the result of complex crosstalk between the adipose tissue and the neighbouring atrial myocardium. For instance, epicardial adipose tissue is a major source of adipokines, inflammatory cytokines, or reactive oxidative species, which can contribute to the fibrotic remodelling of the atrial myocardium. Fibro-fatty infiltrations of the subepicardium could also contribute to the functional disorganization of the atrial myocardium. The observation that obesity is associated with distinct structural and functional remodelling of the atria has opened new perspectives of treating AF substrate with aggressive risk factor management. Advances in cardiac imaging should lead to an improved ability to visualize myocardial fat depositions and to localize AF substrates.
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                Author and article information

                Contributors
                Journal
                Int J Cardiol Heart Vasc
                Int J Cardiol Heart Vasc
                International Journal of Cardiology. Heart & Vasculature
                Elsevier
                2352-9067
                26 January 2019
                March 2019
                26 January 2019
                : 22
                : 132-138
                Affiliations
                Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
                Author notes
                [* ]Corresponding author at: Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany. Sepehria871@ 123456gmail.com
                Article
                S2352-9067(18)30192-1
                10.1016/j.ijcha.2019.01.003
                6356021
                30740509
                25577c20-6635-4fc3-8af5-9cb1d5216af1
                © 2019 The Authors. Published by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 11 November 2018
                : 7 January 2019
                : 9 January 2019
                Categories
                Original Paper

                epicardial fat,adipose tissue,atrial fibrillation,recurrence,risk assessment,prognosis

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