Relationship Between Epicardial Fat Thickness and Cardioversion Success in Patients with Atrial Fibrillation / Atriyal Fibrilasyon Hastalarında Epikardiyal Yağ Kalınlığı ile Kardiyoversiyon Başarısı Arasındaki İlişki

Yıl 2019, , 125 - 130, 20.03.2019

Savaş Özer , Mürsel Şahin Merih Kutlu

https://doi.org/10.31832/smj.486781

Cited By: 3

Öz

Objective: Epicardial fat tissue is known to be arrhythmogenic. In this study we aimed to evaluate if this arrhythmogenic effect affects cardioversion (CV) success in patients with atrial fibrillation (AF).

Materials and Method: We studied 100 AF patients treated with CV in order to restore sinus rhythm. Patients were divided into two groups;  Group 1 patients were successfuly restored sinus rhythm and group 2 were failed to restore sinus rhythm. Demographic characteristics of study population, standard 2 dimensional Doppler and tissue Doppler echocardiographic findings were recorded.

Results: There were 94 patients (59.5±14.1, years) in group 1 and 6 patients (59±8.7, years) in group 2. There were no differences between the two groups in terms of patient demographics. Basic echocardiographic parameters suchas left atrial diameter, left ventricular diameter, septal thicness, ejection fraction, and left ventricular mass index were also similar between two groups. Epicardial fat thickness (EFT) was higher in group 2 patients (p=0.002).

Conclusion: Increased epicardial fat thickness found to be related with reduced CV success rates in the AF patients.

Amaç: Epikardiyal yağ dokusunun aritmojenik etkileri bilinmektedir. Bu çalışmada bu aritmojenik etkinin kardiyoversiyon (KV) başarısı üzerine olan etkisinin araştırılması amaçlanmıştır.

Gereç ve Yöntemler: Çalışmaya sinüs
ritminin sağlanması amacıyla KV uygulanan 100 atriyal fibrilasyon (AF) hastası
alınmıştır. Hastalar iki gruba ayrıldı; 
sinüs ritmi sağlanan hastalar grup 1, sağlanamayan hastalar grup 2 olarak
değerlendirildi.  Çalışma popülasyonunun
karakteristik özellikleri, standart 2 boyutlu ekokardiyografik ölçümler ve doku
doppler ölçümleri kaydedildi.

Bulgular:
Grup
1’de 94 ( ortalama yaş 59,5+-14,1) grup 2’de 6 
(ortalama yaş 59+-8,7) hasta vardı. Temel hasta özellikleri açısından
gruplar arasında fark yoktu. Sol atriyum çapı, sol ventrikül çapları, septal
duvar kalınlıkları, ejeksiyon fraksiyonu ve sol ventrikül kitle indeksi gibi
ekokardiyografik parametreler açısından her iki grup benzerdi. Epikardiyal yağ
kalınlığı (EYK) grup 2 hastalarda daha yüksekti (p=0,002).

Sonuç: Artmış EYK, AF
hastalarında KV başarı oranlarında azalma ile ilişkili bulunmuştur.

Anahtar Kelimeler

Epicardial fat thickness; atrial fibrillation; cardioversion, Epikardiyal yağ kalınlığı; atriyal fibrilasyon; kardiyoversiyon

Kaynakça

• Referans 1: Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2016;50(5):e1-e88.
• Referans 2: Iacobellis G, Bianco AC. Epicardial adipose tissue: emerging physiological, pathophysiological and clinical features. Trends in endocrinology and metabolism: TEM. 2011;22(11):450-7.
• Referans 3: Venteclef N, Guglielmi V, Balse E, Gaborit B, Cotillard A, Atassi F, et al. Human epicardial adipose tissue induces fibrosis of the atrial myocardium through the secretion of adipo-fibrokines. European heart journal. 2015;36(13):795-805a.
• Referans 4: Boixel C, Fontaine V, Rucker-Martin C, Milliez P, Louedec L, Michel JB, et al. Fibrosis of the left atria during progression of heart failure is associated with increased matrix metalloproteinases in the rat. Journal of the American College of Cardiology. 2003;42(2):336-44.
• Referans 5: Shin SY, Yong HS, Lim HE, Na JO, Choi CU, Choi JI, et al. Total and interatrial epicardial adipose tissues are independently associated with left atrial remodeling in patients with atrial fibrillation. Journal of cardiovascular electrophysiology. 2011;22(6):647-55.
• Referans 6: Hatem SN, Sanders P. Epicardial adipose tissue and atrial fibrillation. Cardiovascular research. 2014;102(2):205-13.
• Referans 7: Iacobellis G, Willens HJ, Barbaro G, Sharma AM. Threshold values of high-risk echocardiographic epicardial fat thickness. Obesity (Silver Spring, Md). 2008;16(4):887-92.
• Referans 8: Al Chekakie MO, Welles CC, Metoyer R, Ibrahim A, Shapira AR, Cytron J, et al. Pericardial fat is independently associated with human atrial fibrillation. Journal of the American College of Cardiology. 2010;56(10):784-8.
• Referans 9: Batal O, Schoenhagen P, Shao M, Ayyad AE, Van Wagoner DR, Halliburton SS, et al. Left atrial epicardial adiposity and atrial fibrillation. Circulation Arrhythmia and electrophysiology. 2010;3(3):230-6.
• Referans 10: Iacobellis G, Zaki MC, Garcia D, Willens HJ. Epicardial fat in atrial fibrillation and heart failure. Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme. 2014;46(8):587-90.
• Referans 11: Nagashima K, Okumura Y, Watanabe I, Nakai T, Ohkubo K, Kofune M, et al. Does location of epicardial adipose tissue correspond to endocardial high dominant frequency or complex fractionated atrial electrogram sites during atrial fibrillation? Circulation Arrhythmia and electrophysiology. 2012;5(4):676-83.
• Referans 12: Wong CX, Abed HS, Molaee P, Nelson AJ, Brooks AG, Sharma G, et al. Pericardial fat is associated with atrial fibrillation severity and ablation outcome. Journal of the American College of Cardiology. 2011;57(17):1745-51.
• Referans 13: Thanassoulis G, Massaro JM, O'Donnell CJ, Hoffmann U, Levy D, Ellinor PT, et al. Pericardial fat is associated with prevalent atrial fibrillation: the Framingham Heart Study. Circulation Arrhythmia and electrophysiology. 2010;3(4):345-50.
• Referans 14: Stojanovska J, Kazerooni EA, Sinno M, Gross BH, Watcharotone K, Patel S, et al. Increased epicardial fat is independently associated with the presence and chronicity of atrial fibrillation and radiofrequency ablation outcome. European radiology. 2015;25(8):2298-309.