Evaluate Left Atrial And Epicardial Adipose Tissue By Cardiac CT Angiography With The Recurrence Of Atrial Fibrillation After Cryoballoon Ablation

Objective To investigate the correlation between left atrium and accessory structure,epicardial adipose tissue(EAT)measured by cardiac CT angiography(CCTA)with the recurrence of atrial fibrillation after cryoballoon ablation(CBA).Methods Retrospective analysis of 52 patients with atrial fibrillation who underwent CBA in Wenzhou People’s Hospital between January 2019 to February 2022,and another 20 patients with non-atrial fibrillation who were screened for coronary heart disease were included as subjects.The general data and CCTA parameters were recorded for all patients,including the left atrial volume(LAV),the diameter and volume of left atrial appendage(LAA),the volume and density of EAT and LA-EAT were measured,and the related parameters/body surface area(BSA)were measured.(1)The LAV,the diameter and volume of LAA,the volume and density of EAT and LA-EAT,and the general data were compared between the atrial fibrillation group and the screening group.Logistic regression analysis were used to assess the risk factors related to atrial fibrillation.(2)The relation of BMI with EAT volume,BMI with LA-EAT were investigated using Pearson tests.(3)The LAV,the diameter and volume of LAA,the volume and density of EAT and LA-EAT,and the general data were compared between the recurrent group and the non-recurrent group after CBA.Logistic regression analysis were used to assess the risk factors related to atrial fibrillation recurrence.The best cutoff value of LA-EAT volume and density for predicting atrial fibrillation recurrence was evaluated using the receiver operating characteristic(ROC)curve,and the Kaplan-Meier method was used to analyze the event-free survival rate.Results(1)Compared with the control group,the atrial fibrillation group had larger LAV/BSA(76.12±22.71vs5.24±2.01,P=0.003),LAA deep diameter(3.95±0.67vs3.43±0.44,P=0.002),LAAV/BSA(7.95±3.72vs5.24±2.01,P=0.003),and higherEAT density(-79.73±3.70vs-84.20±6.24,P=0.004),LA-EAT density(-72.37±4.27vs-78.24±6.16,P<0.001).Logistic regression analysis indicated that LAV/BSA(OR=1.08,95%CI 1.00-1.16,P=0.044)is an independent risk factor for atrial fibrillation.(2)Pearson correlation analysis showed that there was a weak but significant correlation between BMI and EATV,LA-EATV(r=0.306,P=0.027;=0.356,P=0.010).(3)Compared with the non-recurrent group,the recurrent group had larger LAV/BSA(89.44±25.63vs70.20±18.78,P=0.004),LAAV/BSA[8.34(6.76,11.90)vs6.61(4.61,8.33),P=0.010],LA-EATV/BSA(12.14±3.45vs10.03±3.49,P=0.049),and higher EAT density(-80.80±6.18vs-85.71±5.76,P=0.008),LA-EAT density(-74.73±5.67vs-79.80±5.78,P=0.005).Logistic regression analysis indicated that LA-EATV/BSA(OR=1.42,95%CI 1.06-1.89,P=0.020)and LA-EAT density(OR=1.46,95%CI 1.012.11,P=0.045)are independent predictors of atrial fibrillation recurrence after CBA.A ROC curve analysis showed that the best cut-off value for predicting atrial fibrillation recurrence were 10.85 cm3/m2 for LA-EATV/BSA(AUC:0.701;sensitivity,75.0%;specificity,66.7%)and-80.81 HU for LA-EAT density(AUC:0.714;sensitivity,93.8%;specificity,50.0%),respectively.Kaplan-Meier analysis showed that there were significant differences in LA-EATV/BSA and LA-EAT density between the two groups in terms of survival rate without recurrence of atrial fibrillation(Log-rank:P=0.013,P=0.022).Conclusion The structural remodeling of the left atrium and left atrial appendage is related to the occurrence of atrial fibrillation;patients with high larger LAV/BSA are more likely to have atrial fibrillation.Compared with BMI,EAT has a stronger correlation with atrial fibrillation.Large LA-EATV/BSA and high LA-EAT density is associated with atrial fibrillation recurrence after CBA in patients with atrial fibrillation,and LA-EATV/BSA>10.85 cm3/m2,LA-EAT density>-80.81 HU could be used to predict atrial fibrillation recurrence after CBA.