Epicardial fat thickness predicts atrial fibrillation recurrence after a first pulmonary vein isolation procedure using a second-generation cryoballoon

Atrial fibrillation is the most common arrhythmia in adults. A relationship between epicardial adipose tissue and atrial fibrillation has recently been reported. To evaluate the impact of epicardial fat thickness on the outcome of patients who underwent a first pulmonary vein isolation procedure using a second-generation cryoballoon. From February 2012 to February 2017, all patients who underwent a first pulmonary vein isolation procedure using a second-generation cryoballoon at Rouen University Hospital were included. Data were collected retrospectively. Epicardial fat thickness was assessed by cardiac magnetic resonance imaging. The primary endpoint was documented atrial fibrillation recurrence at 4 months. A first pulmonary vein isolation procedure using a second-generation cryoballoon was performed in 288 patients; among them, 231 patients (80.2%) underwent cardiac magnetic resonance imaging. Epicardial fat thickness could be measured accurately in 206 patients (71.5%). Recurrence of atrial fibrillation at 4 months occurred in 32/206 patients (15.5%). In the multivariable analysis, factors predictive of atrial fibrillation recurrence at 4 months were: epicardial fat thickness (hazard ratio 1.96, 95% confidence interval 1.20–3.18; P=0.007), the presence of high left atrium enlargement (hazard ratio 4.63, 95% confidence interval 1.17–18.38; P=0.03) and atrial fibrillation recurrence before hospital discharge (hazard ratio 7.55, 95% confidence interval 2.50–22.81; P