Is Epicardial Adipose Tissue Associated with Atrial Fibrillation Following Cardiac Surgery? A Systematic Review and Meta-Analysis

Authors

  • Rina Sha, MD The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
  • Wenqiang Han, MD The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
  • Mingjie Lin, PhD Peking University First Hospital, Beijing, China
  • Jingquan Zhong, PhD Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China

DOI:

https://doi.org/10.1532/hsf.3975

Keywords:

atrial fibrillation, epicardial adipose tissue, cardiac surgery, meta-analysis, echocardiography

Abstract

Background: Although epicardial adipose tissue (EAT) has been proven to be related to atrial fibrillation (AF) and post-ablation AF recurrence, the association between EAT and AF after cardiac surgery (AFACS) remains unclear.

Objective: This study was a systematic review and meta-analysis that assessed the relationship between EAT
and AFACS.

Methods: Electronic databases were systematically searched for “atrial fibrillation” and “epicardial adipose tissue.” The analysis was stratified according to the EAT measurement into three meta-analyses as (1) total EAT volume, (2) left atrial (LA)-EAT volume, and (3) EAT thickness. Standardized mean difference (SMD) was estimated using a random effects model.

Results: Eight articles with 10 studies (546 patients) were included. The meta-analysis revealed that EAT was higher in those with AFACS irrespective of the EAT measurement (total EAT volume: SMD = 0.56 mL, 95% confidence interval, CI = 0.56–1.10 mL, I2 = 0.90, P = .04; EAT thickness: SMD = 0.85 mm, 95% CI = 0.04–1.65 mm, I2 = 0.90, P = .04; LA-EAT volume: SMD = 0.57 mL, 95% CI = 0.23–0.92 mL, I2 = 0.00, P = .001).

Conclusion: EAT was higher in patients with AFACS, measured either as volume or thickness.

References

Ansaldo AM, Montecucco F, Sahebkar A, Dallegri F, Carbone F. 2019. Epicardial adipose tissue and cardiovascular diseases. International Journal of Cardiology. 278:254-260.

Aranki SF, Shaw DP, Adams DH, et al. 1996. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation. 94(3):390-397.

Batal O, Schoenhagen P, Shao M, et al. 2010. Left atrial epicardial adiposity and atrial fibrillation. Circulation Arrhythmia and Electrophysiology. 3(3):230-236.

Bharucha DB, Kowey PR. 2000. Management and prevention of atrial fibrillation after cardiovascular surgery. The American journal of cardiology. 85(10a):20d-24d.

Cheng VY, Dey D, Tamarappoo B, et al. 2010. Pericardial fat burden on ECG-gated noncontrast CT in asymptomatic patients who subsequently experience adverse cardiovascular events. JACC Cardiovascular Imaging. 3(4):352-360.

D'Agostino RS, Jacobs JP, Badhwar V, et al. 2016. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 Update on Outcomes and Quality. The Annals of Thoracic Surgery. 101(1):24-32.

D'Agostino RS, Jacobs JP, Badhwar V, et al. 2018. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Outcomes and Quality. The Annals of Thoracic Surgery. 105(1):15-23.

Deng H, Bai Y, Shantsila A, Fauchier L, Potpara TS, Lip GYH. 2017. Clinical scores for outcomes of rhythm control or arrhythmia progression in patients with atrial fibrillation: a systematic review. Clinical research in cardiology: official journal of the German Cardiac Society. 106(10):813-823.

Ding J, Hsu FC, Harris TB, et al. 2009. The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA). The American Journal of Clinical Nutrition. 90(3):499-504.

Drossos G, Koutsogiannidis CP, Ananiadou O, et al. 2014. Pericardial fat is strongly associated with atrial fibrillation after coronary artery bypass graft surgery†. European journal of cardiothoracic surgery: official journal of the European Association for Cardiothoracic Surgery. 46(6):1014-1020; discussion 1020.

Dutour A, Abdesselam I, Ancel P, et al. 2016. Exenatide decreases liver fat content and epicardial adipose tissue in patients with obesity and type 2 diabetes: a prospective randomized clinical trial using magnetic resonance imaging and spectroscopy. Diabetes, Obesity & Metabolism. 18(9):882-891.

Echahidi N, Pibarot P, O'Hara G, Mathieu P. 2008. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. Journal of the American College of Cardiology. 51(8):793-801.

Gaborit B, Jacquier A, Kober F, et al. 2012. Effects of bariatric surgery on cardiac ectopic fat: lesser decrease in epicardial fat compared to visceral fat loss and no change in myocardial triglyceride content. Journal of the American College of Cardiology. 60(15):1381-1389.

Gaita F, Scaglione M, Battaglia A, et al. 2018. Very long-term outcome following transcatheter ablation of atrial fibrillation. Are results maintained after 10 years of follow up? Europace: European pacing, arrhythmias, and cardiac electrophysiology: journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 20(3):443-450.

Ghaderi F, Eshraghi A, Shamloo AS, Mousavi S. 2016. Association of Epicardial and Pericardial Fat Thickness with Coronary Artery Disease. Electronic physician. 8(9):2982-2989.

Grosso AF, de Oliveira SF, Higuchi Mde L, Favarato D, Dallan LA, da Luz PL. 2014. Synergistic anti-inflammatory effect: simvastatin and pioglitazone reduce inflammatory markers of plasma and epicardial adipose tissue of coronary patients with metabolic syndrome. Diabetology & Metabolic Syndrome. 6(1):47.

Gu J, Andreasen JJ, Melgaard J, et al. 2017. Preoperative Electrocardiogram Score for Predicting New-Onset Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 31(1):69-76.

Gunturk EE, Topuz M, Serhatlioğlu F, Akkaya H. 2020. Echocardiographically Measured Epicardial Fat Predicts New-onset Atrial Fibrillation after Cardiac Surgery. Brazilian Journal of Cardiovascular Surgery. 35(3):339-345.

Haemers P, Hamdi H, Guedj K, et al. 2017. Atrial fibrillation is associated with the fibrotic remodelling of adipose tissue in the subepicardium of human and sheep atria. European Heart Journal. 38(1):53-61.

Hatem SN. 2015. Atrial Fibrillation and Obesity: Not Just a Coincidence. Journal of the American College of Cardiology. 2015;66(1):12-13.

Hogue CW, Jr., Hyder ML. 2000. Atrial fibrillation after cardiac operation: risks, mechanisms, and treatment. The Annals of Thoracic Surgery. 69(1):300-306.

Jakubová M, Mitro P, Stančák B, et al. 2012. The occurrence of postoperative atrial fibrillation according to different surgical settings in cardiac surgery patients. Interactive Cardiovascular and Thoracic Surgery. 15(6):1007-1012.

Kogo H, Sezai A, Osaka S, Shiono M, Tanaka M. 2019. Does Epicardial Adipose Tissue Influence Postoperative Atrial Fibrillation? Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 25(3):149-157.

Lima-Martínez MM, Paoli M, Rodney M, et al. 2016. Effect of sitagliptin on epicardial fat thickness in subjects with type 2 diabetes and obesity: a pilot study. Endocrine. 51(3):448-455.

Liu Q, Zhang F, Yang M, Zhong J. 2020. Increasing Level of Interleukin-1β in Epicardial Adipose Tissue Is Associated with Persistent Atrial Fibrillation. Journal of interferon & cytokine research: the official journal of the International Society for Interferon and Cytokine Research. 40(1):64-69.

Mahabadi AA, Massaro JM, Rosito GA, et al. 2009. Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study. European Heart Journal. 30(7):850-856.

Mahajan R, Lau DH, Brooks AG, et al. 2015. Electrophysiological, Electroanatomical, and Structural Remodeling of the Atria as Consequences of Sustained Obesity. Journal of the American College of Cardiology. 66(1):1-11.

Mazurek T, Zhang L, Zalewski A, et al. 2003. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 108(20):2460-2466.

Nerlekar N, Baey YW, Brown AJ, et al. 2018. Poor Correlation, Reproducibility, and Agreement Between Volumetric Versus Linear Epicardial Adipose Tissue Measurement: A 3D Computed Tomography Versus 2D Echocardiography Comparison. JACC Cardiovascular Imaging. 11(7):1035-1036.

Opolski MP, Staruch AD, Kusmierczyk M, et al. 2015. Computed tomography angiography for prediction of atrial fibrillation after coronary artery bypass grafting: proof of concept. Journal of Cardiology. 65(4):285-292.

Ozbek K, Katlandur H, Arik B, et al. 2018. Role of red blood cell distribution width and epicardial fat in atrial fibrillation after cardiopulmonary bypass. Electron J Gen Med. 15(2):7.

Parisi V, Petraglia L, D'Esposito V, et al. 2019. Statin therapy modulates thickness and inflammatory profile of human epicardial adipose tissue. International Journal of Cardiology. 274:326-330.

Pokushalov E, Kozlov B, Romanov A, et al. 2015. Long-Term Suppression of Atrial Fibrillation by Botulinum Toxin Injection Into Epicardial Fat Pads in Patients Undergoing Cardiac Surgery: One-Year Follow-Up of a Randomized Pilot Study. Circulation Arrhythmia and Electrophysiology. 8(6):1334-1341.

Rachwalik M, Obremska M, Zyśko D, Matusiewicz M, Ściborski K, Jasiński M. 2019. The concentration of resistin in perivascular adipose tissue after CABG and postoperative atrial fibrillation. BMC Cardiovascular Disorders. 19(1):294.

Rosito GA, Massaro JM, Hoffmann U, et al. 2008. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation. 117(5):605-613.

Rossi P, Ricci A, De Paulis R, et al. 2012. Epicardial ganglionated plexus stimulation decreases postoperative inflammatory response in humans. Heart Rhythm. 9(6):943-950.

Sato T, Aizawa Y, Yuasa S, et al. 2018. The effect of dapagliflozin treatment on epicardial adipose tissue volume. Cardiovascular Diabetology. 17(1):6.

Schwann TA, Al-Shaar L, Engoren MC, et al. 2018. Effect of new-onset atrial fibrillation on cause-specific late mortality after coronary artery bypass grafting surgery. European journal of cardio-thoracic surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 54(2):294-301.

Shen J, Lall S, Zheng V, Buckley P, Damiano RJ, Jr., Schuessler RB. 2011. The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades. The Journal of Thoracic and Cardiovascular Surgery. 141(2):559-570.

Shimabukuro M, Hirata Y, Tabata M, et al. 2013. Epicardial adipose tissue volume and adipocytokine imbalance are strongly linked to human coronary atherosclerosis. Arteriosclerosis, Thrombosis, and Vascular Biology. 33(5):1077-1084.

Thanassoulis G, Massaro JM, O'Donnell CJ, et al. 2010. Pericardial fat is associated with prevalent atrial fibrillation: the Framingham Heart Study. Circulation Arrhythmia and Electrophysiology. 3(4):345-350.

Tran DT, Perry JJ, Dupuis JY, Elmestekawy E, Wells GA. 2015. Predicting New-Onset Postoperative Atrial Fibrillation in Cardiac Surgery Patients. Journal of Cardiothoracic and Vascular Anesthesia. 29(5):1117-1126.

Venteclef N, Guglielmi V, Balse E, et al. 2015. Human epicardial adipose tissue induces fibrosis of the atrial myocardium through the secretion of adipo-fibrokines. European Heart Journal. 36(13):795-805a.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. 2014. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. International Journal of Surgery (London, England). 12(12):1495-1499.

Wang TJ, Parise H, Levy D, et al. 2004. Obesity and the risk of new-onset atrial fibrillation. Jama. 292(20):2471-2477.

Wang Q, Min J, Jia L, et al. 2019. Human Epicardial Adipose Tissue Activin A Expression Predicts Occurrence of Postoperative Atrial Fibrillation in Patients Receiving Cardiac Surgery. Heart, Lung & Circulation. 28(11):1697-1705.

Wong CX, Abed HS, Molaee P, et al. 2011. Pericardial fat is associated with atrial fibrillation severity and ablation outcome. Journal of the American College of Cardiology. 57(17):1745-1751.

Wong CX, Ganesan AN, Selvanayagam JB. 2017. Epicardial fat and atrial fibrillation: current evidence, potential mechanisms, clinical implications, and future directions. European Heart Journal. 38(17):1294-1302.

Wong CX, Sun MT, Odutayo A, et al. 2016. Associations of Epicardial, Abdominal, and Overall Adiposity With Atrial Fibrillation. Circulation Arrhythmia and Electrophysiology. 9(12).

Xu Y, Cheng X, Hong K, Huang C, Wan L. 2012. How to interpret epicardial adipose tissue as a cause of coronary artery disease: a meta-analysis. Coronary Artery Disease. 23(4):227-233.

Zghaib T, Ipek EG, Zahid S, et al. 2016. Association of left atrial epicardial adipose tissue with electrogram bipolar voltage and fractionation: Electrophysiologic substrates for atrial fibrillation. Heart Rhythm. 13(12):2333-2339.

Zhang W, Liu W, Chew ST, Shen L, Ti LK. 2016. A Clinical Prediction Model for Postcardiac Surgery Atrial Fibrillation in an Asian Population. Anesthesia and Analgesia. 123(2):283-289.

Zhou M, Wang H, Chen J, Zhao L. 2020. Epicardial adipose tissue and atrial fibrillation: Possible mechanisms, potential therapies, and future directions. Pacing and Clinical Electrophysiology: PACE. 43(1):133-145

Published

2021-09-13

How to Cite

Sha, R., Han, W., Lin, M., & Zhong, J. (2021). Is Epicardial Adipose Tissue Associated with Atrial Fibrillation Following Cardiac Surgery? A Systematic Review and Meta-Analysis. The Heart Surgery Forum, 24(5), E801-E807. https://doi.org/10.1532/hsf.3975

Issue

Section

Articles