ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2025
Left atrial intramyocardial fat at pulmonary vein reconnection sites during atrial fibrillation redo ablation.
Article in 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, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Personalized pulmonary vein isolation guided by left atrial wall thickness for persistent atrial fibrillation ablation: the PeAF-by-LAWT randomized trial.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 · 2025Trial
- Pulsed Field Ablation for Atrial Fibrillation in Obesity: Reassessing Risk, Safety, and Success.Journal of clinical medicine · 2026Review
- Atrial Fibrillation in Diabetes: Epidemiology, Mechanisms and Integrated Management.Journal of clinical medicine · 2026Review
- Semaglutide as adjunctive therapy to catheter ablation in obesity-related paroxysmal atrial fibrillation.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 · 2026Article
- Atypical atrial flutter ablation: clinical practice on patient selection, mapping, ablation strategies, and procedural endpoints-results from a European Heart Rhythm Association survey.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 · 2025Article
- Targeting the Substrate: Mechanism-Based Ablation Strategies for Persistent Atrial Fibrillation.Journal of clinical medicine · 2025Review
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Authors and funding
21 authors.
Funding
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Abstract
aimsElectrical reconnections between pulmonary veins (PVs) and the left atrium (LA) are frequently responsible for atrial fibrillation (AF) recurrences after pulmonary vein isolation (PVI). Multidetector computed tomography (MDCT)-derived images can be post-processed to detect intramyocardial fat (inFAT) by signal radiodensity thresholding. The role of inFAT on PV-LA reconnections remains unknown. The aim of this study was to analyse the relationship between inFAT localization at pre-procedural MDCT-derived inFAT maps from first AF ablation and PV-LA reconnections in patients with AF recurrence undergoing redo ablation. METHODS AND
resultsWe included 45 consecutive patients who underwent AF redo ablation presenting at least one PV-LA reconnection. First AF ablation pre-procedural MDCT-derived data were post-processed with ADAS 3D™ to create 3D LA inFAT maps, which were loaded into CARTO3 navigation system and merged with the electroanatomical map for reconnection site analysis. In 103 out of 156 (66.0%), PV-LA reconnection points inFAT was identified in the 6 mm diameter tag point depicted in the navigation system. When dividing the PVI line into standardized segments, those identified as containing PV-LA reconnection points (i.e. reconnection segments) exhibited significantly higher total inFAT volumes compared with non-reconnection segments (8.05 ± 6.56 vs. 5.40 ± 5.18 μL, P < 0.001). Additionally, reconnection segments showed greater volumes of inFAT components, specifically dense inFAT (0.06 ± 0.06 vs. 0.03 ± 0.04 μL, P < 0.001) and fat-myocardial admixture (7.98 ± 6.52 vs. 5.37 ± 5.16 μL, P < 0.001).
conclusionIntramyocardial fat is co-localized with two-thirds of PV-LA reconnection points in patients undergoing AF redo ablation. Reconnection segments exhibit significantly higher inFAT volumes compared to non-reconnection segments. This proof-of-concept study suggests that inFAT may play a role in PV-LA electrical reconnections following PVI.
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