Author + information
- Received August 12, 2010
- Revision received October 21, 2010
- Accepted November 1, 2010
- Published online April 26, 2011.
- Christopher X. Wong⁎,
- Hany S. Abed, MBBS, BPharm⁎,
- Payman Molaee, MBBS⁎,
- Adam J. Nelson, BMedSc⁎,
- Anthony G. Brooks, PhD⁎,
- Gautam Sharma, MD⁎,
- Darryl P. Leong, MBBS⁎,
- Dennis H. Lau, MBBS⁎,
- Melissa E. Middeldorp⁎,
- Kurt C. Roberts-Thomson, MBBS, PhD⁎,
- Gary A. Wittert, MD⁎,
- Walter P. Abhayaratna, MBBS, PhD†,
- Stephen G. Worthley, MBBS, PhD⁎ and
- Prashanthan Sanders, MBBS, PhD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Prashanthan Sanders, Centre for Heart Rhythm Disorders (CHRD), Cardiovascular Investigation Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
Objectives The aim of this study was to characterize the relationship between pericardial fat and atrial fibrillation (AF).
Background Obesity is an important risk factor for AF. Pericardial fat has been hypothesized to exert local pathogenic effects on nearby cardiac structures above and beyond that of systemic adiposity.
Methods One hundred ten patients undergoing first-time AF ablation and 20 reference patients without AF underwent cardiac magnetic resonance imaging for the quantification of periatrial, periventricular, and total pericardial fat volumes using a previously validated technique. Together with body mass index and body surface area, these were examined in relation to the presence of AF, the severity of AF, left atrial volume, and long-term AF recurrence after ablation.
Results Pericardial fat volumes were significantly associated with the presence of AF, AF chronicity, and AF symptom burden (all p values <0.05). Pericardial fat depots were also predictive of long-term AF recurrence after ablation (p = 0.035). Finally, pericardial fat depots were also associated with left atrial volume (total pericardial fat: r = 0.46, p < 0.001). Importantly, these associations persisted after multivariate adjustment and additional adjustment for body weight. In contrast, however, systemic measures of adiposity, such as body mass index and body surface area, were not associated with these outcomes in multivariate-adjusted models.
Conclusions Pericardial fat is associated with the presence of AF, the severity of AF, left atrial volumes, and poorer outcomes after AF ablation. These associations are both independent of and stronger than more systemic measures of adiposity. These findings are consistent with the hypothesis of a local pathogenic effect of pericardial fat on the arrhythmogenic substrate supporting AF.
Mr. Wong is supported by the Rhodes Scholarship from the Rhodes Trust and by Student Scholarships from the National Heart Foundation of Australia (NHFA) and the University of Adelaide. Dr. Abed is supported by the Australian Postgraduate Award Scholarship from the University of Adelaide. Drs. Molaee and Leong are supported by Postgraduate Medical Scholarships from the National Health and Medical Research Council of Australia (NHMRC) and the NHFA. Dr. Lau is supported by a Postgraduate Medical Scholarship from the NHMRC, the Earl Bakken Electrophysiology Scholarship from the University of Adelaide, and a Kidney Health Australia Biomedical Research Scholarship. Drs. Brooks, Roberts-Thomson, and Sanders are supported by the NHFA. Dr. Roberts-Thomson has served on the advisory board of St. Jude Medical. Dr. Sanders has served on the advisory board of and has received lecture fees and research funding from Bard Electrophysiology, Biosense Webster, Medtronic, St. Jude Medical, Merck Sharp & Dohme, and Sanofi-Aventis. All other authors have reported that they have no relationships to disclose. This report was presented in part at the 31st Annual Scientific Sessions of the Heart Rhythm Society, Denver, Colorado, May 2010, and published in abstract form (Heart Rhythm 2010;7:S327). The first 3 authors contributed equally to this work.
- Received August 12, 2010.
- Revision received October 21, 2010.
- Accepted November 1, 2010.
- American College of Cardiology Foundation