{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T16:11:52Z","timestamp":1789747912582,"version":"4.0.1"},"reference-count":31,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: In patients undergoing paroxysmal atrial fibrillation (PAF) ablation, pulmonary vein isolation (PVI) alone fails in maintaining sinus rhythm in up to one third of patients after a first catheter ablation. Epicardial adipose tissue (EAT), as an endocrine-active organ, could play a role in the recurrence of AF after catheter ablation. Objective: To evaluate the predictive value of clinical, echocardiographic, biological parameters and epicardial fat density measured by computed tomography scan (CT-scan) on AF recurrence in PAF patients who underwent a first pulmonary vein isolation procedure using radiofrequency (RF). Methods: This monocentric retrospective study included all patients undergoing first-time RF PAF ablation at the Nancy University Hospital between March 2015 and December 2018 with one-year follow-up. Results: 389 patients were included, of whom 128 (32.9%) had AF recurrence at one-year follow-up. Neither total-EAT volume (88.6 \u00b1 37.2 cm3 vs. 91.4 \u00b1 40.5 cm3, p = 0.519), nor total-EAT radiodensity (\u221298.8 \u00b1 4.1 HU vs. \u221298.8 \u00b1 3.8 HU, p = 0.892) and left atrium-EAT radiodensity (\u221293.7 \u00b1 4.3 HU vs. \u221293.4 \u00b1 6.0 HU, p = 0.556) were significantly associated with AF recurrence after PAF ablation. In multivariate analysis, previous cavo-tricuspid isthmus (CTI) ablation, ablation procedure duration, BNP and triglyceride levels remained independently associated with AF recurrence after catheter ablation at 12-months follow-up. Conclusion: Contrary to persistent AF, EAT parameters are not associated with AF recurrence after paroxysmal AF ablation. Thus, the role of the metabolic atrial substrate in PAF pathophysiology appears less obvious than in persistent AF.<\/jats:p>","DOI":"10.3390\/jcm10143037","type":"journal-article","created":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T04:32:49Z","timestamp":1625718769000},"page":"3037","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Is There an Association between Epicardial Adipose Tissue and Outcomes after Paroxysmal Atrial Fibrillation Catheter Ablation?"],"prefix":"10.3390","volume":"10","author":[{"given":"N\u00e9fissa","family":"Hammache","sequence":"first","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHRU de Nancy, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"},{"name":"INSERM-IADI, U1254, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Pegorer-Sfes","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHRU de Nancy, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Benali","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHRU de Nancy, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"},{"name":"INSERM-IADI, U1254, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"},{"name":"D\u00e9partement de Cardiologie, CHU de Saint-Etienne, 42270 Saint-Priest-en-Jarez, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Magnin Poull","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHRU de Nancy, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"},{"name":"INSERM-IADI, U1254, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaud","family":"Olivier","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHRU de Nancy, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Echivard","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHRU de Nancy, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Pace","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHRU de Nancy, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Minois","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHRU de Nancy, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"},{"name":"INSERM-IADI, U1254, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"},{"name":"D\u00e9partement de Cardiologie, CHU de Nantes, 44000 Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Sadoul","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHRU de Nancy, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"},{"name":"INSERM-IADI, U1254, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Mandry","sequence":"additional","affiliation":[{"name":"INSERM-IADI, U1254, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"},{"name":"D\u00e9partement de Radiologie, CHRU de Nancy, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1080-7425","authenticated-orcid":false,"given":"Jean Marc","family":"Sellal","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHRU de Nancy, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"},{"name":"INSERM-IADI, U1254, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9025-6821","authenticated-orcid":false,"given":"Christian","family":"de Chillou","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHRU de Nancy, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"},{"name":"INSERM-IADI, U1254, F-54500 Vand\u0153uvre-l\u00e8s-Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1161\/CIRCULATIONAHA.113.005119","article-title":"Worldwide epidemiology of atrial fibrillation: A Global Burden of Disease 2010 Study","volume":"129","author":"Chugh","year":"2014","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1001\/jama.2009.2029","article-title":"Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: A randomized controlled trial","volume":"303","author":"Wilber","year":"2010","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e004549","DOI":"10.1161\/JAHA.112.004549","article-title":"Long-term outcomes of catheter ablation of atrial fibrillation: A systematic review and meta-analysis","volume":"2","author":"Ganesan","year":"2013","journal-title":"J. Am. Heart Assoc."},{"key":"ref_5","first-page":"1303","article-title":"Contemporary management of patients undergoing atrial fibrillation ablation: In-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry","volume":"38","author":"Arbelo","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_6","first-page":"443","article-title":"Very long-term outcome following transcatheter ablation of atrial fibrillation. Are results maintained after 10 years of follow up?","volume":"20","author":"Gaita","year":"2018","journal-title":"Ep Eur."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.ahj.2018.05.020","article-title":"A randomized clinical trial of early invasive intervention for atrial fibrillation (EARLY-AF)\u2014Methods and rationale","volume":"206","author":"Andrade","year":"2018","journal-title":"Am. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1056\/NEJMoa2019422","article-title":"Early Rhythm-Control Therapy in Patients with Atrial Fibrillation","volume":"383","author":"Kirchhof","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1056\/NEJMoa2029554","article-title":"Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation","volume":"384","author":"Wazni","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"12686","DOI":"10.1038\/s41598-018-31133-x","article-title":"Prediction of electro-anatomical substrate and arrhythmia recurrences using APPLE, DR-FLASH and MB-LATER scores in patients with atrial fibrillation undergoing catheter ablation","volume":"8","author":"Kornej","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_11","first-page":"1294","article-title":"Epicardial fat and atrial fibrillation: Current evidence, potential mechanisms, clinical implications, and future directions","volume":"38","author":"Wong","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1080\/03007995.2018.1462786","article-title":"Epicardial adipose tissue and atrial fibrillation: Pathophysiological mechanisms, clinical implications, and potential therapies","volume":"34","author":"Goudis","year":"2018","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.ijcard.2015.05.129","article-title":"Pericardial fat and atrial fibrillation: Epidemiology, mechanisms and interventions","volume":"195","author":"Proietti","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e004614","DOI":"10.1161\/CIRCEP.116.004614","article-title":"Association Between Posterior Left Atrial Adipose Tissue Mass and Atrial Fibrillation","volume":"10","author":"Leung","year":"2017","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_15","first-page":"132","article-title":"Is epicardial fat tissue associated with atrial fibrillation recurrence after ablation? A systematic review and meta-analysis","volume":"22","author":"Shamloo","year":"2019","journal-title":"Int. J. Cardiol. Heart Vasc."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Bonou, M., Mavrogeni, S., Kapelios, C., Markousis-Mavrogenis, G., Aggeli, C., Cholongitas, E., Protogerou, A., and Barbetseas, J. (2021). Cardiac Adiposity and Arrhythmias: The Role of Imaging. Diagnostics, 11.","DOI":"10.3390\/diagnostics11020362"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.2337\/db10-0004","article-title":"Impact of age on the relationships of brown adipose tissue with sex and adiposity in humans","volume":"59","author":"Pfannenberg","year":"2010","journal-title":"Diabetes"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1016\/j.jacc.2010.11.045","article-title":"Pericardial fat is associated with atrial fibrillation severity and ablation outcome","volume":"57","author":"Wong","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.ijcard.2014.08.008","article-title":"Pericardial fat volume is associated with clinical recurrence after catheter ablation for persistent atrial fibrillation, but not paroxysmal atrial fibrillation: An analysis of over 600-patients","volume":"176","author":"Kim","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.jacc.2010.03.071","article-title":"Pericardial fat is independently associated with human atrial fibrillation","volume":"56","author":"Welles","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1161\/CIRCEP.110.957241","article-title":"Left atrial epicardial adiposity and atrial fibrillation","volume":"3","author":"Batal","year":"2010","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2225","DOI":"10.1016\/j.jacc.2011.05.061","article-title":"Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age","volume":"58","author":"Platonov","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1016\/j.jacep.2018.08.014","article-title":"Electroanatomical Remodeling of the Atria in Obesity: Impact of Adjacent Epicardial Fat","volume":"4","author":"Mahajan","year":"2018","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_24","first-page":"e009135","article-title":"Posterior Left Atrial Adipose Tissue Attenuation Assessed by Computed Tomography and Recurrence of Atrial Fibrillation After Catheter Ablation","volume":"14","author":"Simon","year":"2021","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.jacep.2016.10.006","article-title":"Recurrent Post-Ablation Paroxysmal Atrial Fibrillation Shares Substrates With Persistent Atrial Fibrillation: An 11-Center Study","volume":"3","author":"Zaman","year":"2017","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2786","DOI":"10.1161\/CIRCULATIONAHA.107.711622","article-title":"Can common-type atrial flutter be a sign of an arrhythmogenic substrate in paroxysmal atrial fibrillation? Clinical and ablative consequences in patients with coexistent paroxysmal atrial fibrillation\/atrial flutter","volume":"116","author":"Moreira","year":"2007","journal-title":"Circulation"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1536\/ihj.15-355","article-title":"Association Between Baseline Natriuretic Peptides and Atrial Fibrillation Recurrence After Catheter Ablation","volume":"57","author":"Zhang","year":"2016","journal-title":"Int. Heart J."},{"key":"ref_28","first-page":"392","article-title":"Association of pre-ablation level of potential blood markers with atrial fibrillation recurrence after catheter ablation: A meta-analysis","volume":"19","author":"Jiang","year":"2017","journal-title":"EP Eur."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"H2318","DOI":"10.1152\/ajpheart.2001.281.6.H2318","article-title":"Natriuretic peptides like NO facilitate cardiac vagal neurotransmission and bradycardia via a cGMP pathway","volume":"281","author":"Herring","year":"2001","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_30","first-page":"252","article-title":"High prevalence of paroxysmal atrial fibrillation and\/or atrial flutter in metabolic syndrome","volume":"71","author":"Umetani","year":"2007","journal-title":"Circ. J. Off. J. Jpn. Circ. Soc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1016\/j.jacc.2011.11.051","article-title":"Impact of metabolic syndrome on procedural outcomes in patients with atrial fibrillation undergoing catheter ablation","volume":"59","author":"Mohanty","year":"2012","journal-title":"J. Am. Coll. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/14\/3037\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:27:39Z","timestamp":1760164059000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/14\/3037"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,8]]},"references-count":31,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["jcm10143037"],"URL":"https:\/\/doi.org\/10.3390\/jcm10143037","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,8]]}}}