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


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
Issue number12
StatePublished - Dec 1 2016



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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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