Effect of pulsed field ablation on epicardial fat in patients with atrial fibrillation.

Doctor Francis Ha, Monash University

Postgraduate Scholarship

Years funded: 2026 - 2028

Obesity is a well-established risk factor for atrial fibrillation (AF). Epicardial adipose tissue (EAT) - the fat deposit that surrounds the heart - has a greater association with AF compared with traditional measures of obesity. As part of the treatment for AF, ablation commonly around the pulmonary veins has been shown to significantly reduce risk of AF recurrence compared with medications. This has been performed using thermal technology such as radiofrequency or cryoballoon modalities, however a recently adopted ablation modality is pulsed field ablation (PFA). Pulsed field ablation affects cell membrane through electroporation without reliance upon thermal energy that can damage tissues. This novel technology shows promising safety and efficacy compared with traditional thermal energy modalities. Thermal ablation technology has been shown to reduce epicardial fat around the left atrium. The primary aim of our research will be to evaluate the effects of PFA on EAT. Secondary aims of our study will be to correlate electroanatomic mapping from their PFA procedure to their EAT volume and density.

We will prospectively recruit patients with paroxysmal or persistent AF to undergo a cardiac computed tomography (CT) scan prior to their PFA and then a repeat cardiac CT at 6 months post-procedure to evaluate EAT volume and attenuation. We will also collect electroanatomic mapping parameters of the left atrium at the time of their PFA. We will perform statistical analyses to determine changes in EAT before and after PFA and to correlate local electroanatomic mapping parameters with EAT volume and changes.

Demonstrating the role of PFA in affecting EAT will advance our understanding of the mechanisms of AF. In understanding the role of ablation in AF management, we can provide better management of care of patients with AF, particularly in patients with increased body mady mass index. The combination of lifestyle modification, weight loss and the role of ablation in the context can be better understood.

We plan to translate our findings directly to clinical practice by providing a holistic care of patients with AF from lifestyle modification, anti-arrhythmic drug therapy and understanding the role of ablation procedures in the context. We plan to disseminate our scientific findings into journal publications, participation in print, telivision and radio media and dissemination across non-for-profit organisations such as the Heart Foundation.