Tarek Zghaib1, Esra Gucuk Ipek2, Sohail Zahid3, Muhammad Adnan Balouch2, Satish Misra2, Hiroshi Ashikaga4, Ronald D Berger4, Joseph E Marine2, David D Spragg2, Stefan L Zimmerman5, Vadim Zipunnikov6, Natalia Trayanova3, Hugh Calkins2, Saman Nazarian7. 1. Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: tzghaib1@jhmi.edu. 2. Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland. 4. Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland. 5. Department of Radiology, The Johns Hopkins School of Medicine, Baltimore, Maryland. 6. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 7. Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Medicine/Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
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.
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.
Authors: Jun Dong; Hugh Calkins; Stephen B Solomon; Shenghan Lai; Darshan Dalal; Albert C Lardo; Al Lardo; Erez Brem; Assaf Preiss; Ronald D Berger; Henry Halperin; Timm Dickfeld Journal: Circulation Date: 2006-01-09 Impact factor: 29.690
Authors: Laszlo Saghy; David J Callans; Fermin Garcia; David Lin; Francis E Marchlinski; Michael Riley; Sanjay Dixit; Wendy S Tzou; Harris M Haqqani; Robert Pap; Steven Kim; Edward P Gerstenfeld Journal: Heart Rhythm Date: 2011-09-23 Impact factor: 6.343
Authors: Atul Verma; Oussama M Wazni; Nassir F Marrouche; David O Martin; Fethi Kilicaslan; Stephen Minor; Robert A Schweikert; Walid Saliba; Jennifer Cummings; J David Burkhardt; Mandeep Bhargava; William A Belden; Ahmad Abdul-Karim; Andrea Natale Journal: J Am Coll Cardiol Date: 2005-01-18 Impact factor: 24.094
Authors: Hany S Abed; Chrishan S Samuel; Dennis H Lau; Darren J Kelly; Simon G Royce; Muayad Alasady; Rajiv Mahajan; Pawel Kuklik; Yuan Zhang; Anthony G Brooks; Adam J Nelson; Stephen G Worthley; Walter P Abhayaratna; Jonathan M Kalman; Gary A Wittert; Prashanthan Sanders Journal: Heart Rhythm Date: 2012-09-01 Impact factor: 6.343
Authors: Marco V Perez; Paul J Wang; Joseph C Larson; Elsayed Z Soliman; Marian Limacher; Beatriz Rodriguez; Liviu Klein; Joann E Manson; Lisa W Martin; Ronald Prineas; Stephanie Connelly; Mark Hlatky; Sylvia Wassertheil-Smoller; Marcia L Stefanick Journal: Heart Date: 2013-06-11 Impact factor: 5.994
Authors: Luisa Ciuffo; Hieu Nguyen; Mateus Diniz Marques; Konstantinos N Aronis; Bhradeev Sivasambu; Henrique D de Vasconcelos; Susumu Tao; David D Spragg; Joseph E Marine; Ronald D Berger; Joao A C Lima; Hugh Calkins; Hiroshi Ashikaga Journal: Circ Cardiovasc Imaging Date: 2019-06-10 Impact factor: 7.792
Authors: Rheeda L Ali; Joe B Hakim; Patrick M Boyle; Sohail Zahid; Bhradeev Sivasambu; Joseph E Marine; Hugh Calkins; Natalia A Trayanova; David D Spragg Journal: Cardiovasc Res Date: 2019-10-01 Impact factor: 10.787