Arrhythmias & electrophysiologyCohort study
Epicardial adipose tissue in paroxysmal and persistent atrial fibrillation ablation using photon counting CT and automated 3D atrial segmentation: The Prospective AFAT Study
- prospective observational study
Authors' conclusion
PCCT enables precise biatrial EAT quantification. LA EAT was associated with arrhythmia recurrence in persistent but not in paroxysmal AF, supporting its potential as an imaging biomarker.
Study context
- Population
- Adults undergoing first-time catheter ablation for paroxysmal or persistent atrial fibrillation (AF) at the German Heart Centre Munichadults undergoing first-time catheter ablation
- Participants
- 210 adults
- Exposure
- paroxysmal AF vs persistent AF
- Outcome
- Freedom from any atrial arrhythmia after an 8-week blanking period, assessed by 7-day Holter monitoring at 3, 6, and 12 months
- Follow-up
- 1 year
Main finding
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | hazard ratio (95% CI) | |
|---|---|---|
| Arrhythmia recurrence per 10-mL increase in LA EAT (multivariable Cox regression) — LA EAT per 10-mL increase · persistent AF | 1.51 (1.06–2.15) | |
| Arrhythmia recurrence per 10-mL increase in LA EAT (multivariable Cox regression) — LA EAT per 10-mL increase · paroxysmal AF | 0.79 (0.54–1.15) | |
| 0.512Hazard ratio (log scale) |
| Outcome | paroxysmal AF | persistent AF | Estimate |
|---|---|---|---|
| LA and right atrial EAT by AF type · higher in persistent AF | |||
| LA EAT | 28.0 | 32.1 | |
| right atrial EAT | 27.7 | 33.4 |
- Arrhythmia recurrence per 10-mL increase in left atrial (LA) epicardial adipose tissue (EAT) (multivariable Cox regression): P for interaction = .014
- LA and right atrial EAT by AF type: P < .01
Baseline characteristics
- Median age
- 68.0 years
- Median body mass index
- 27.0 (interquartile range [IQR] = 24.5-30.0) kg/m²
Biatrial EAT volume
- Median left atrial (LA) EAT volume
- 30.4 (IQR = 23.5-40.1) mL
- Median right atrial EAT
- 31.2 (IQR = 23.8-38.0) mL
- Correlation of LA and right atrial EAT
- r = 0.92, P < .0001
LA EAT and low-voltage substrate
- LA EAT was not associated with low-voltage substrate
Original publication
Epicardial adipose tissue in paroxysmal and persistent atrial fibrillation ablation using photon counting CT and automated 3D atrial segmentation: The Prospective AFAT Study. Heart Rhythm. Published 18 September 2026. doi:10.1016/j.hrthm.2026.09.019
Summarised from the published abstract; every number is checked against it