AUTHOR=Zhu Jing , Zhuo Kaimin , Zhang Bo , Xie Zhen , Li Wenjia 

TITLE=Sex Differences in Epicardial Adipose Tissue: Association With Atrial Fibrillation Ablation Outcomes

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.905351

DOI=10.3389/fcvm.2022.905351

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>There are significant differences in the prevalence and prognosis of atrial fibrillation (AF) between sexes. Epicardial adipose tissue (EAT) has been found as a risk factor for AF. This study aimed to evaluate whether sex-based EAT differences were correlated with AF recurrence and major adverse cardiovascular events (MACE).</p></sec><sec><title>Methods</title><p>In this study, postmenopausal women and age, BMI, and type of AF matched men who had received first catheter ablation were included. EAT volume was quantified based on the pre-ablation cardiac computed tomography (CT) images. Clinical, CT, and echocardiographic variables were compared by sex groups. The predictors of AF recurrence and MACE were determined through Cox proportional hazards regression.</p></sec><sec><title>Results</title><p>Women were found with significantly lower total EAT volumes (<italic>P</italic> &lt; 0.001) but higher periatrial/total (P/T) EAT ratios (<italic>P</italic> = 0.009). The median follow-up duration was 444.5 days. As revealed by the result of the Kaplan-Meier survival analysis, the women were found to have a significantly higher prevalence of AF recurrence (log rank, <italic>P</italic> = 0.011) but comparable MACE (log rank, <italic>P</italic> = 0.507) than men. Multivariate analysis demonstrated that female gender (HR: 1.88 [95% CI: 1.03, 4.15], <italic>P</italic> = 0.032), persistent AF (HR: 2.46 [95% CI: 1.19, 5.05], <italic>P</italic> = 0.015), left atrial (LA) dimension (HR: 1.47 [95% CI: 1.02, 2.13], <italic>P</italic> = 0.041), and P/T EAT ratio (HR: 1.73 [95% CI: 1.12, 2.67], <italic>P</italic> = 0.013) were found as the independent predictors of AF recurrence. Sex-based subgroup multivariable analysis showed that the P/T EAT ratio was an independent predictor of AF recurrence in both men (HR: 1.13 [95% CI: 1.01, 1.46], <italic>P</italic> = 0.047) and women (HR: 1.37 [95% CI: 1.11, 1.67], <italic>P</italic> = 0.028). While age (HR: 1.81 [95% CI: 1.18, 2.77], <italic>P</italic> = 0.007), BMI (HR: 1.44 [95% CI: 1.02, 2.03], <italic>P</italic> = 0.038), and periatrial EAT volume (HR: 1.31 [95% CI: 1.01, 1.91], <italic>P</italic> = 0.046) were found to be independent of MACE.</p></sec><sec><title>Conclusion</title><p>Women had a higher P/T EAT ratio and AF post-ablation recurrence but similar MACE as compared with men. Female gender and P/T EAT ratio were found to be independent predictors of AF recurrence, whereas age and periatrial EAT volume were found to be independent predictors of MACE.</p></sec>