Comparison of left atrial volume, left atrial appendage volume, and epicardial adipose tissue volume between patients with paroxysmal and persistent atrial fibrillation
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Abstract
Abstract
Objective: This study aimed to evaluate differences in left atrial volume (LAV), left atrial appendage volume (LAAV), and epicardial fat volume (EFV) between patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PersAF), while analyzing the association of these factors with disease progression.
Methods: A cross-sectional study was conducted on 58 AF patients undergoing radiofrequency ablation, who underwent cardiac multidetector computed tomography (MDCT) at Bach Mai Hospital from January 2024 to May 2025. Left atrial, left atrial appendage, and epicardial fat volumes were measured using Syngo.via software.
Results: The study included 58 AF patients (72.4% PAF, 27.6% PersAF) with a mean age of 60.5 ± 9.2 years, revealing significant anatomical differences. The PersAF group had significantly larger LAV (126.6 ± 51.0 ml vs. 83.4 ± 19.6 ml, p < 0.001) and LAAV (18.3 ± 9.7 ml vs. 12.7 ± 6.2 ml, p = 0.004) compared to the PAF group. Multivariate regression analysis adjusted for confounders confirmed that PersAF independently increased LAV by 22.5 ml (95% CI 13.1–31.9, p < 0.001) and LAAV by 4.25 ml (95% CI 0.16–8.34, p= 0.041). Notably, although initial differences in EFV and left atrial–specific EFV (LA-EFV) were observed (p < 0.05), these became non-significant after adjustment (EFV: β = 6.3, p = 0.166; LA-EFV: β = 2.4, p = 0.093). Independent predictors of increased EFV and LA-EFV included male sex, higher BMI, and hypertension (p < 0.05). These findings provide evidence of cardiac remodeling in PersAF and suggest a complex pathogenesis involving anatomical and metabolic factors.
Conclusion: The study confirms significant differences in LAV and LAAV between PAF and PersAF patients. However, the association between epicardial fat volume and AF subtype remains unclear, warranting further investigation.
Keywords
atrial fibrillation, left atrial volume, left atrial appendage volume, epicardial fat volume.
Article Details
References
2. Kirchhof, P. et al. (2016) ‘2016 ESC Guidelines for the management of atrial fibrillation developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC’, European Heart Journal, 37(38), pp. 2893-2962. doi:10.1093/eurheartj/ehw210.
3. Verma, A. et al. (2015) ‘Approaches to catheter ablation for persistent atrial fibrillation’, New England Journal of Medicine, 372(19), pp. 1812-1822. doi:10.1056/NEJMoa1408288.
4. Clarnette, J.A. et al. (2018) ‘Outcomes of persistent and long-standing persistent atrial fibrillation ablation: a systematic review and meta-analysis’, Europace, 20, pp. f366-f376. doi:10.1093/europace/eux297.
5. Wong, C.X., Sun, M.T., Odutayo, A. et al., 2016. Associations of epicardial, abdominal, and overall adiposity with atrial fibrillation. Circulation: Arrhythmia and Electrophysiology, 9(12), e004378. https://doi.org/10.1161/CIRCEP.116.004378
6. Pongratz, J. et al. (2025) ‘Comparative analysis of left atrial size and appendage morphology in paroxysmal and persistent atrial fibrillation patients’, Journal of Arrhythmia, 41(3), p.e13224.doi:10.1002/joa3.13224.
7. Dudzińska-Szczerba, K., et al. (2022). Association between left atrial appendage morphology and function and the risk of ischaemic stroke in patients with atrial fibrillation. PMC. PMCID: PMC9272406,PMID: 35846423.
8. Shin, S.Y. et al. (2011) ‘Total and interatrial epicardial adipose tissues are independently associated with left atrial remodeling in patients with atrial fibrillation’, Journal of Cardiovascular Electrophysiology, 22(6), pp. 647-655. doi:10.1111/j.1540-8167.2010.01993.x.
9. Xue Enzhong, Jing Qiangqiang %J Scientific Programming. Optimized Reconstruction Algorithm-Processed CT Image in the Diagnosis of Correlation between Epicardial Fat Volume andCoronary Heart Disease.2022;2022(1):2883175.
10. Trương Thị Thanh. (2023) So sánh đặc điểm hình ảnh cắt lớp vi tính tương phản kép một pha với siêu âm tim qua thực quản trong đánh giá tiểu nhĩ trái ở bệnh nhân rung nhĩ. Luận văn Thạc sĩ Y học. Trường Đại học Y Hà Nội.
11. Korhonen M, Muuronen A, Arponen O, et al. Left Atrial Appendage Morphology in Patients with Suspected Cardiogenic Stroke without Known Atrial Fibrillation. PLoS ONE. 2015;10(3):e0118822. doi:10.1371/journal. pone.0118822
12. Kimura T, Takatsuki S, Inagawa K, et al. Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores. Heart Rhythm. 2013;10(6):921-925. doi:10.1016/j.hrthm.2013.01.036
13. Tachibana, S. et al. (2024) ‘Segmental evaluation of predictive value of left atrial epicardial adipose tissue following catheter ablation for atrial fibrillation’, International Journal of Cardiology, p. 132558. doi:10.1016/j.ijcard.2024.132558.
14. Al Chekakie, M.O. et al. (2010) ‘Pericardial fat is independently associated with human atrial fibrillation’, Journal of the American College of Cardiology, 56(10), pp. 784-788.
15. Park, H.-C. et al. (2013) ‘Left atrial appendage: morphology and function in patients with paroxysmal and persistent atrial fibrillation’, The International Journal of Cardiovascular Imaging, 29(5), pp. 935-944.
16. Park, J.-H. et al. (2024) ‘Left atrium volume measured with multislice computed tomography as a prognostic predictor for atrial fibrillation catheter ablation outcomes’, Journal of Clinical Medicine, 13(7), p. 1859. doi:10.3390/jcm13071859.