Arrhythmias & electrophysiology
Substrate Comprising Fibrosis and Epicardial Adipose Tissue-Associated Electrophysiological Remodeling Can Sustain Atrial Fibrillation Drivers: Insights from Image-Personalized Computational Simulations
Authors' conclusion
Adding EAT effects to fibrosis-based models increased sustained functional reentry, with transmural depth contributing only modestly. Reentry anchored preferentially where fibrosis and EAT effects coexisted.
Study context
- Population
- Patients with persistent atrial fibrillation (AF), left atrial (LA) fibrosis and epicardial adipose tissue (EAT) quantified by LGE and Dixon MRIpatients, 855 simulations
- Participants
- 19 patients
- Comparison
- Fibrosis-based models with vs without EAT-associated effects
- Outcome
- Sustained reentry
Main finding
As reported in the abstract
Simulations with sustained reentry
370 simulations
43.3%
Of which with a functional (rotor-driven) component
306
Further findings
Functional reentry inducibility
Models with at least one functional reentry fibrosis only 12/19 · half-EAT 18/19 · full-EAT 19/19
Median
| Outcome | Fibrosis only | half-EAT | full-EAT | P value | |
|---|---|---|---|---|---|
| Median inducible simulations per patienthalf-EAT vs fibrosis only | 4 | 6 | 7 | P = 0.004 | |
| Median inducible simulations per patientfull-EAT vs fibrosis only | P = 0.003 | ||||
| Median inducible simulations per patienthalf-EAT vs full-EAT · no significant difference | P = 0.895 | ||||
| Volume harboring reentry by tissue region | 37.3% | Not reported in the abstract | Not reported in the abstract | half-EAT, full-EAT: not reported in the abstract |
- Volume harboring reentry by tissue region: Fibrosis/EAT overlap median 65.5% · Share of LA wall 2.1%
- Volume harboring reentry by tissue region: non-substrate median 8.8%
- Volume harboring reentry by tissue region: EAT median 42.8%
- Volume harboring reentry by tissue region: all p<0.001
1-year recurrence in PVI-only ablation patients (exploratory)
- Fibrosis-EAT overlap outside the PVI region associated with 1-year recurrence
- log-rank p=0.007
- Exploratory analysis
- n=13
Original publication
Substrate Comprising Fibrosis and Epicardial Adipose Tissue-Associated Electrophysiological Remodeling Can Sustain Atrial Fibrillation Drivers: Insights from Image-Personalized Computational Simulations. Heart Rhythm. Published 9 October 2026. doi:10.
Summarised from the published abstract; every number is checked against it