Comparison of Left Atrial Volume, Left Atrial Appendage Volume, and Epicardial Adipose Tissue Volume Between Patients with Paroxysmal and Persistent Atrial Fibrillation

Abstract

Objective: This study aimed to evaluate differences in left atrial volume (LAV), left atrial appendage volume (LAAV), and epicardial fat volume (EFV) between patients with paroxysmal atrial fibrillation (PAF)
and persistent atrial fibrillation (PersAF), while analyzing the association of these factors with disease progression.
Methods: A cross-sectional study was conducted on 58 AF patients undergoing radiofrequency ablation, who underwent cardiac multidetector computed tomography (MDCT) at Bach Mai Hospital from January 2024 to May 2025. Left atrial, left atrial appendage, and epicardial fat volumes were measured using Syngo.via software.
Results: The study included 58 AF patients (72.4% PAF, 27.6% PersAF) with a mean age of 60.5 ± 9.2 years, revealing significant anatomical differences. The PersAF group had significantly larger LAV (126.6 ± 51.0
ml vs. 83.4 ± 19.6 ml, p < 0.001) and LAAV (18.3 ± 9.7 ml vs. 12.7 ± 6.2 ml, p = 0.004) compared to the PAF group. Multivariate regression analysis adjusted for confounders confirmed that PersAF independently increased LAV by 22.5 ml (95% CI 13.1–31.9, p < 0.001) and LAAV by 4.25 ml (95% CI 0.16–8.34, p= 0.041). Notably, although initial differences in EFV and left atrial–specific EFV (LA-EFV) were observed (p < 0.05), these became non-significant after adjustment (EFV: β = 6.3, p = 0.166; LA-EFV: β = 2.4, p = 0.093). Independent predictors of increased EFV and LA-EFV included male sex, higher BMI, and hypertension (p < 0.05). These findings provide evidence of cardiac remodeling in PersAF and suggest a complex pathogenesis involving anatomical and metabolic factors.
Conclusion: The study confirms significant differences in LAV and LAAV between PAF and PersAF patients. However, the association between epicardial fat volume and AF subtype remains unclear, warranting
further investigation.