Pericardial fat and metabolic syndrome indexies in patients undergoing atrial fibrillation ablation

Background

Metabolic syndrome and epicardial adipose tissue (EAT) play a crucial role in atrial fibrillation (AF). Several metabolic markers have recently been identified, generating growing interest due to emerging evidence linking them to cardiovascular disease and major clinical outcomes.

Objective

The aim of this study was to investigate the correlation between metabolic indices and coronary CT measures of epicardial fat, in order to identify parameters related to arrhythmia pathophysiology and their possible association with AF recurrence.

Methods

We conducted a retrospective, bicentric observational study including patients who underwent coronary CT prior to catheter ablation for AF between October 2020 and November 2023. A total of 140 patients were enrolled. We analyzed major inflammatory indices (TyG, TyG-BMI, NHR, PHR, CONUT score, NLR, PLR, and METS-IR) and epicardial fat parameters (total EAT volume and density, left atrial EAT volume and density), stratified by age and sex. Subsequently, we assessed correlations between metabolic indices and epicardial fat characteristics.

Results

Table 1. Comparison by sex revealed a statistically significant difference in the NHR parameter and left para-atrial fat density. NHR, a composite marker reflecting both inflammatory status (neutrophils) and lipid metabolism (HDL), was higher in males. Conversely, epicardial fat density was higher in females, suggesting a possible localized inflammatory process. Comparison by age showed that NHR was higher in younger patients.

Table 2. Correlation analyses demonstrated a significant positive association between the TyG and TyG-BMI indices—markers of metabolic risk derived from lipid and carbohydrate profiles—and both total epicardial fat volume and left para-atrial fat volume. The CONUT score, an indicator of poor nutritional status, was inversely correlated with the ratio of para-atrial fat volume to total epicardial fat volume

Conclusion

Higher para-atrial fat density values suggest a potential link with local inflammatory activity, particularly in females, who are known to experience worse AF outcomes. These findings support an etiopathogenetic mechanism possibly explaining the sex-related differences reported in AF.

The observed correlations between TyG, TyG-BMI, and CONUT indices and epicardial fat parameters highlight an interesting relationship, given the established pathophysiological role of EAT in AF and metabolic syndrome. Due to their non-invasive nature, these indices—derived from routine laboratory and biometric data—may serve as useful tools with potential clinical implications in the comprehensive assessment of AF patients. Long-term analyses of cardiovascular outcomes and arrhythmic recurrence rates are ongoing.Table 1Table 2