Atrial fibrillation (AF) is the most common arythmia in adult population. A relationship between epicardial adipose tissue and AF has recently been reported.

The objective of this study was to evaluate the impact of epicardial fat thickness (EFT) on the outcome of patients who underwent a first pulmonary vein isolation (PVI) procedure using second generation cryoballoon.

From February 2012 to February 2017, all patients who underwent a first PVI procedure using second generation cryoballoon in Rouen University Hospital were included. Data were retrospectively collected. EFT was assessed by cardiac magnetic resonance imagery (cMRI). Measures were preformed the long side of the right ventricle free wall on axial view in end diastolic time. The primary endpoint was documented AF recurrences at four months. Secondary endpoints were: EFT measurements, and AF recurrences before hospital discharge.

PVI procedure was performed in 288 patients. Among them, 231 patients (80.2%) had a cMRI. EFT could be appropriately measured in 206 patients. Recurrences of AF at four months occurred in 32/206 patients (15.5%). In multivariate analysis, predictive factors of AF recurrences at four months were: EFT, the presence of high left atrium enlargement and AF recurrences before hospital discharge (respectively, HR=1.96, 95% CI: 1.20–3.18, P=0.007; HR=4.63, 95% CI: 1.17–18.38, P=0.03, and HR=7.55, 95% CI: 2.50–22.81, P<0.001). The best cutoff value of EFT to predict AF recurrences at four months was equal to 4.35mm (Se=0.75, and Sp=0.60).

EFT is an independent predictive factor of AF recurrences at four months after a first PVI procedure using second generation cryoballoon. In accordance with other studies, epicardial adipose tissue seems to be intimately bound to AF physiopathology.