Association of left atrial epicardial adipose tissue with electrogram bipolar voltage and fractionation

Electrophysiologic substrates for atrial fibrillation

Tarek Zghaib, Esra Gucuk Ipek, Sohail Zahid, Muhammad Adnan Balouch, Satish Misra, Hiroshi Ashikaga, Ronald D Berger, Joseph Marine, David D Spragg, Stefan Zimmerman, Vadim Zipunnikov, Natalia Trayanova, Hugh Calkins, Saman Nazarian

Research output: Contribution to journalArticle

Abstract

Background Epicardial adipose tissue (EAdT) is metabolically active and likely contributes to atrial fibrillation (AF) through the release of inflammatory cytokines into the myocardium or through its rich innervation with ganglionated plexi at the pulmonary vein ostia. The electrophysiologic mechanisms underlying the association between EAdT and AF remain unclear. Objective The purpose of this study was to investigate the association of EAdT with adjacent myocardial substrate. Methods Thirty consecutive patients who underwent cardiac computed tomography as well as electroanatomic mapping in sinus rhythm before an initial AF ablation procedure were studied. Semiautomatic segmentation of atrial EAdT was performed and registered anatomically to the voltage map. Results In multivariable regression analysis clustered by patient, age (–0.01 per year) and EAdT (–0.29) were associated with log bipolar voltage as well as low-voltage zones (<0.5 mV). Age (odds ratio [OR]: 1.02 per year), male gender (OR: 3.50), diabetes (OR: 2.91), hypertension (OR: 2.55), and EAdT (OR: 8.56) were associated with fractionated electrograms, and age (OR: 2.80), male gender (OR: 3.00), and EAdT (OR: 7.03) were associated with widened signals. Age (OR: 1.03 per year) and body mass index (OR: 1.06 per kg/m2) were associated with atrial fat. Conclusion The presence of overlaying EAdT was associated with lower bipolar voltage and electrogram fractionation as electrophysiologic substrates for AF. EAdT was not a statistical mediator of the association between clinical variables and AF substrate. Body mass index was directly associated with the presence of EAdT in patients with AF.

Original languageEnglish (US)
Pages (from-to)2333-2339
Number of pages7
JournalHeart Rhythm
Volume13
Issue number12
DOIs
StatePublished - Dec 1 2016

Fingerprint

Atrial Fibrillation
Adipose Tissue
Odds Ratio
Body Mass Index
Pulmonary Veins
Myocardium
Fats
Tomography
Regression Analysis
Cytokines
Hypertension

Keywords

  • Arrhythmias
  • Atrial fibrillation
  • Bipolar voltage
  • Computerized tomography
  • Epicardial adipose tissue
  • Fibrosis
  • Signal fractionation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Association of left atrial epicardial adipose tissue with electrogram bipolar voltage and fractionation : Electrophysiologic substrates for atrial fibrillation. / Zghaib, Tarek; Ipek, Esra Gucuk; Zahid, Sohail; Balouch, Muhammad Adnan; Misra, Satish; Ashikaga, Hiroshi; Berger, Ronald D; Marine, Joseph; Spragg, David D; Zimmerman, Stefan; Zipunnikov, Vadim; Trayanova, Natalia; Calkins, Hugh; Nazarian, Saman.

In: Heart Rhythm, Vol. 13, No. 12, 01.12.2016, p. 2333-2339.

Research output: Contribution to journalArticle

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abstract = "Background Epicardial adipose tissue (EAdT) is metabolically active and likely contributes to atrial fibrillation (AF) through the release of inflammatory cytokines into the myocardium or through its rich innervation with ganglionated plexi at the pulmonary vein ostia. The electrophysiologic mechanisms underlying the association between EAdT and AF remain unclear. Objective The purpose of this study was to investigate the association of EAdT with adjacent myocardial substrate. Methods Thirty consecutive patients who underwent cardiac computed tomography as well as electroanatomic mapping in sinus rhythm before an initial AF ablation procedure were studied. Semiautomatic segmentation of atrial EAdT was performed and registered anatomically to the voltage map. Results In multivariable regression analysis clustered by patient, age (–0.01 per year) and EAdT (–0.29) were associated with log bipolar voltage as well as low-voltage zones (<0.5 mV). Age (odds ratio [OR]: 1.02 per year), male gender (OR: 3.50), diabetes (OR: 2.91), hypertension (OR: 2.55), and EAdT (OR: 8.56) were associated with fractionated electrograms, and age (OR: 2.80), male gender (OR: 3.00), and EAdT (OR: 7.03) were associated with widened signals. Age (OR: 1.03 per year) and body mass index (OR: 1.06 per kg/m2) were associated with atrial fat. Conclusion The presence of overlaying EAdT was associated with lower bipolar voltage and electrogram fractionation as electrophysiologic substrates for AF. EAdT was not a statistical mediator of the association between clinical variables and AF substrate. Body mass index was directly associated with the presence of EAdT in patients with AF.",
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T1 - Association of left atrial epicardial adipose tissue with electrogram bipolar voltage and fractionation

T2 - Electrophysiologic substrates for atrial fibrillation

AU - Zghaib, Tarek

AU - Ipek, Esra Gucuk

AU - Zahid, Sohail

AU - Balouch, Muhammad Adnan

AU - Misra, Satish

AU - Ashikaga, Hiroshi

AU - Berger, Ronald D

AU - Marine, Joseph

AU - Spragg, David D

AU - Zimmerman, Stefan

AU - Zipunnikov, Vadim

AU - Trayanova, Natalia

AU - Calkins, Hugh

AU - Nazarian, Saman

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N2 - Background Epicardial adipose tissue (EAdT) is metabolically active and likely contributes to atrial fibrillation (AF) through the release of inflammatory cytokines into the myocardium or through its rich innervation with ganglionated plexi at the pulmonary vein ostia. The electrophysiologic mechanisms underlying the association between EAdT and AF remain unclear. Objective The purpose of this study was to investigate the association of EAdT with adjacent myocardial substrate. Methods Thirty consecutive patients who underwent cardiac computed tomography as well as electroanatomic mapping in sinus rhythm before an initial AF ablation procedure were studied. Semiautomatic segmentation of atrial EAdT was performed and registered anatomically to the voltage map. Results In multivariable regression analysis clustered by patient, age (–0.01 per year) and EAdT (–0.29) were associated with log bipolar voltage as well as low-voltage zones (<0.5 mV). Age (odds ratio [OR]: 1.02 per year), male gender (OR: 3.50), diabetes (OR: 2.91), hypertension (OR: 2.55), and EAdT (OR: 8.56) were associated with fractionated electrograms, and age (OR: 2.80), male gender (OR: 3.00), and EAdT (OR: 7.03) were associated with widened signals. Age (OR: 1.03 per year) and body mass index (OR: 1.06 per kg/m2) were associated with atrial fat. Conclusion The presence of overlaying EAdT was associated with lower bipolar voltage and electrogram fractionation as electrophysiologic substrates for AF. EAdT was not a statistical mediator of the association between clinical variables and AF substrate. Body mass index was directly associated with the presence of EAdT in patients with AF.

AB - Background Epicardial adipose tissue (EAdT) is metabolically active and likely contributes to atrial fibrillation (AF) through the release of inflammatory cytokines into the myocardium or through its rich innervation with ganglionated plexi at the pulmonary vein ostia. The electrophysiologic mechanisms underlying the association between EAdT and AF remain unclear. Objective The purpose of this study was to investigate the association of EAdT with adjacent myocardial substrate. Methods Thirty consecutive patients who underwent cardiac computed tomography as well as electroanatomic mapping in sinus rhythm before an initial AF ablation procedure were studied. Semiautomatic segmentation of atrial EAdT was performed and registered anatomically to the voltage map. Results In multivariable regression analysis clustered by patient, age (–0.01 per year) and EAdT (–0.29) were associated with log bipolar voltage as well as low-voltage zones (<0.5 mV). Age (odds ratio [OR]: 1.02 per year), male gender (OR: 3.50), diabetes (OR: 2.91), hypertension (OR: 2.55), and EAdT (OR: 8.56) were associated with fractionated electrograms, and age (OR: 2.80), male gender (OR: 3.00), and EAdT (OR: 7.03) were associated with widened signals. Age (OR: 1.03 per year) and body mass index (OR: 1.06 per kg/m2) were associated with atrial fat. Conclusion The presence of overlaying EAdT was associated with lower bipolar voltage and electrogram fractionation as electrophysiologic substrates for AF. EAdT was not a statistical mediator of the association between clinical variables and AF substrate. Body mass index was directly associated with the presence of EAdT in patients with AF.

KW - Arrhythmias

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KW - Bipolar voltage

KW - Computerized tomography

KW - Epicardial adipose tissue

KW - Fibrosis

KW - Signal fractionation

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