Patients with persistent atrial fibrillation and metabolic comorbidities have an altered inflammatory state of atrial epicardial adipose tissue, which is linked to CT-attenuation
Authors' conclusion
Patients with persistent versus paroxysmal AF exhibited increased EAT neutrophils, which is reflected by CT-EAT-attenuation. Those with AF recurrence, hypertension and diabetes had adipocyte hypertrophy which may imply a common mechanism underlying these conditions.
Study context
- Population
- Patients undergoing thoracoscopic ablation for advanced Atrial fibrillation (AF) (usually persistent, enlarged left atria, previous failed ablations) with cardiac CT before and 6 months after surgery113 with LAA available
- Participants
- 134 patients
- Exposure
- Persistent vs paroxysmal AF; recurrence vs no recurrence
- Outcome
- EAT inflammatory composition by AF type
Methodological detailshistological and immunohistochemical analysis of excised left atrial appendages, cardiac CT before and 6 months after surgery
- Histological and immunohistochemical analysis of excised left atrial appendages
- Cardiac CT before and 6 months after surgery
Main finding
As reported in the abstract
| Group | Value | CD163 + macrophages | CT-EAT-attenuation |
|---|---|---|---|
| Persistent AF | 155 (unspecified 257) cells/mm² | 126[134] | - 73.0 ± 4.6 HU |
| Paroxysmal AF | 63 (unspecified 106) cells/mm² | 224[179] | - 75.3 ± 5.3HU |
Value
Persistent AF155 (unspecified 257) cells/mm²
Paroxysmal AF63 (unspecified 106) cells/mm²
CD163 + macrophages
Persistent AF126[134]
Paroxysmal AF224[179]
CT-EAT-attenuation
Persistent AF- 73.0 ± 4.6 HU
Paroxysmal AF- 75.3 ± 5.3HU
- Persistent AF vs Paroxysmal AF: P = 0.003 — more with persistent AF
- Persistent AF vs Paroxysmal AF: P = 0.03 — less with persistent AF
- Persistent AF vs Paroxysmal AF: P = 0.03
- AUC of neutrophil-count for persistent vs paroxysmal AF
- 0.75 (CI 0.63-0.87, p value < 0.001)
Observational data: associations, not effects.
Further findings
Epicardial adipose tissue (EAT) neutrophil-count and CT-EAT-attenuation
- Multivariable expB
- 1.01, CI 1.00-1.02, (p = 0.04)
- Multivariable analysis
AF recurrence vs no recurrence
- Larger adipocytes with recurrence, multivariable ExpB
- 1.002, CI 1.00-1.003, (p = 0.02)
- Similar inflammatory cell counts
- Multivariable analysis
Adipocyte size in hypertension and DM
- Hypertensive and diabetic patients had increased adipocyte size
Original publication
Patients with persistent atrial fibrillation and metabolic comorbidities have an altered inflammatory state of atrial epicardial adipose tissue, which is linked to CT-attenuation. Cardiovasc Diabetol. Published 26 December 2025. doi:10.
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