What Are Good Predictors for Therapeutic Success or Recurrence of Atrial Fibrillation After Concomitant Surgical Ablation?

All articles of this category (opens in new window) Background: Obesity is an independent risk factor for atrial fibrillation (AF) and influences disease progression, leading to more persistent AF types. There is evidence for a direct impact of epicardial adipose tissue on the underlying myocardium via paracrine and cellular interactions mediating cardiac remodeling. Here, we investigated the predictive value of adipokine release and expression for the therapeutic success of concomitant surgical ablation in patients with persistent/permanent AF. Methods: Patients with paroxysmal ( n = 30) or long-standing persistent/permanent AF ( n = 37) underwent standardized biatrial ablation concomitant to cardiac surgery, including implantation of a loop recorder (ILR). Blood samples, left atrial (LA), and epicardial adipose tissue (EAT) were obtained. The follow-up (2 years) included physical examination, ILR-readout, 12-lead ECG, 24-hour Holter-monitoring, echocardiography, and blood sampling every 6 months. Patient samples were analyzed by RT-qPCR, Western Blot, histology, and ELISA. Results: Freedom from AF was reached in all patients with paroxysmal and 65% of patients with persistent/permanent AF. Patients with AF recurrence had higher body mass index (BMI) after the follow-up and increased fibrosis markers (LA histology, collagen mRNA expression, TGF-beta1, and Activin A serum levels). LA tissue of these patients also demonstrated disturbed SERCA/NCX expression, Connexin 43 (Cx43) lateralization, and disturbed Cx40/43 expression, all parameters previously associated with AF persistence. Epicardial adipose tissue showed a significant increase in pro-fibrotic cytokines and adipokines and a deficiency in anti-fibrotic, anti-inflammatory adipokines such as Acrp30. Higher BMI correlated positively with serum Leptin, Activin A, and TGF-beta1 and negatively with Acrp30. Univariate analyses suggested that higher preoperative serum Leptin or Activin A ( p < 0.05) elevated the risk of AF recurrence, while higher preoperative Acrp30 favors sinus rhythm (SR). A constant increase in serum TGF-beta 1, Activating A or ANP was only observed in patients with AF recurrence, suggesting continuing adverse remodeling during 24 months of follow-up. Conclusion: Increasing BMI and the release of pro-fibrotic adipokines and cytokines are associated with AF recurrence. Tissue and blood markers focusing on these mediators can help to predict the therapeutic success of concomitant surgical ablation. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany