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Background  Metabolic syndrome/epicardial adipose tissue ( EAT ) plays an important role in atrial fibrillation ( AF ). Although reverse atrial remodeling ( RAR ) often occurs after  AF  ablation, the effects of  EAT  on  RAR  remain unknown.    Methods  Study subjects were 104 patients in whom transthoracic echocardiography ( TTE ) was performed before  AF  ablation and 3, 6, and 12 months afterward.  EAT  was assessed in terms of its thickness adjacent to the right ventricular anterior wall in the  TTE  parasternal view.  RAR  was defined as >10% reduction in the left atrial volume ( LAV ) index by the 3‐month follow‐up examination.    Results  Postablation  RAR  occurred in 57/104 (55%) patients.  RAR  absence was associated with a relatively thick  EAT  (4.92 ± 1.65 vs. 3.92 ± 1.17 mm,  P  =   0.0005), small  LAV  index (24.6 ± 7.5 vs. 28.8 ± 10.6 mL/m 2 ,  P  =   0.0233), and metabolic syndrome (62% vs. 28%,  P  =   0.0006). Metabolic syndrome and  EAT  were shown to be independent predictors of  RAR  absence. Thick  EAT  was significantly associated with  AF  recurrence after ablation (5.05 ± 2.19 mm vs. 4.17 ± 1.16 mm for no  AF  recurrence group,  P  =   0.0116), but metabolic syndrome was not (48% vs. 42%,  P  =   0.6189). Despite no change in body weight,  EAT  thickness decreased significantly by 12 months in patients without  AF  recurrence (4.17 ± 1.16 vs. 3.65 ± 1.16 mm,  P  <   0.0001).    Conclusions   EAT  and metabolic syndrome appear to be strongly associated with  RAR  absence, but only the thick  EAT  was significantly associated with the postablation  AF  recurrence. Our findings, especially the thinning of  EAT , suggest that thick  EAT  lead to  AF  vulnerability but that  EAT  reduction favorably affects ablation outcome.

Effect of epicardial fat and metabolic syndrome on reverse atrial remodeling after ablation for atrial fibrillation