Epicardial adipose tissue (EAT), through a paracrine secretion of various molecules, seems to be implicated in left atrial (LA) adverse remodelling, promoting persistent atrial fibrillation (PersAF). Computed tomography (CT) density appears to be a marker of EAT secretory activity.

We sought to assess whether EAT density alone or combined with EAT volume is associated with the occurrence of PersAF after a first catheter ablation (CA) procedure.

This retrospective study included all consecutive patients undergoing a first CA procedure for PersAF in Nancy University Hospital in 2016 and 2017 with a one-year follow-up. Cardiac CT performed before the ablation allowed quantitative (volume) and qualitative (density) analysis of EAT.

One hundred and seventy-seven patients were included. After adjustment, determinants of EAT volume were age (β=0.97, P=0.014), triglycerides level (β=10.61, P=0.002), LA area (β=4.06, P<0.001), and LA volume (β=−1.05, P=0.005). Overall EAT density was associated with increased BMI (β=0.19, P=0.005) and BNP level (β=0.002, P=0.005), while peri-LA EAT density correlated with higher BMI (β=0.37, P=0.01) and total cholesterol level (β=2.53, P=0.017). Patients showing AF recurrence were more likely to be females (30.2% vs. 14.8%, P=0.016), diabetics (21.9% vs. 9.9%, P=0.032) and symptomatic (NYHA III/IV: 20.8% vs. 8.6%, P=0.025). AF recurrence was associated with a lower density of overall EAT (−97.7±4.4 vs. −96.3±3.9, P=0.024) and peri-LA EAT (P<0.001).

EAT density assessed by cardiac CT seems to be correlated with the risk of recurrence after a first PersAF CA. EAT density might be useful to predict PersAF recurrence after CA and could also become a therapeutic target.