Left atrial epicardial adipose tissue exacerbates electrical conduction disturbance in normal‐weight patients undergoing pulmonary vein isolation for atrial fibrillation

Abstract

Introduction Epicardial adipose tissue (EAT) exacerbates both electrical and structural remodeling in obese atrial fibrillation (AF) patients, but the impacts of EAT on atrial arrhythmogenicity remain unclear in normal‐weight AF patients. Therefore, we sought to investigate this issue using electroanatomic mapping. Methods and Results We enrolled drug‐refractory 105 paroxysmal AF patients in the normal body mass index range (18.5–24.9 kg/m2), who had undergone electroanatomic mapping after pulmonary vein isolation (PVI). One day before PVI, we assessed P‐wave duration in a 12‐lead electrocardiogram and left atrial (LA)‐EAT volumes using contrast‐enhanced computed tomography. The patients were divided into two groups based on the median LA‐EAT volume (16.0 ml); the high LA‐EAT group (≥16.0 ml, n = 53) and low LA‐EAT group (<16.0 ml, n = 52). We compared P‐wave duration, LA conduction velocity and bipolar voltage, the presence of low‐voltage zone (<0.5 mV), and LA volume index on echocardiography between the two groups. The LA bipolar voltage, low‐voltage zone, and LA volume index were not different between the high and low LA‐EAT groups. However, P‐wave duration was significantly longer in the high group than in the low group (p < .001). Additionally, the LA conduction velocity was significantly more depressed in the high group than in the low group (p < .001). Multivariate linear regression analysis revealed that LA‐EAT volume was correlated with P‐wave duration (β = .367, p < .001) and conduction velocity (β = −.566, p < .001), respectively. Conclusions Increased LA‐EAT volumes were associated with electrical conduction disturbance after PVI in normal‐weight patients with AF. P‐wave duration may be a clinically useful predictor of LA‐EAT.

Utility of short‐time electrocardiogram to assess risk for atrial arrhythmia recurrence: Impact of atrial premature beat occurrence 1 day after pulmonary vein isolation for atrial fibrillation

“…The detailed procedural protocol of PVI using RFCA and CBA at our institution was as described previously 6,12,13 . Before the procedure, all antiarrhythmic agents were ceased for a minimum of five half‐lives.…”

“…Fast anatomical mapping was used to create an LA geometry, and the color interpolation threshold for mapping points was set at 5. The low‐voltage area was defined as areas with a bipolar peak‐to‐peak voltage amplitude of <0.5 mV covering >5 cm 2 of the LA 13 . PVI was performed using a point‐to‐point technique with an Ablation Index module (Biosense Webster) 6,12,13 .…”

“…The detailed procedural protocol of PVI using RFCA and CBA at our institution was as described previously. 6,12,13 Before the procedure, all antiarrhythmic agents were ceased for a minimum of five half-lives. With regard to the RFCA procedures, LA geometry was created using a 20-pole circular catheter (Lasso-NaV, Biosense Webster, Inc.), and then PVI was performed using ThermoCool SmartTouch SF ablation catheter (Biosense Webster) under the guidance of the CARTO system (Biosense Webster).…”

“…The low-voltage area was defined as areas with a bipolar peak-to-peak voltage amplitude of <0.5 mV covering >5 cm 2 of the LA. 13 PVI was performed using a point-to-point technique with an Ablation Index module (Biosense Webster). 6,12,13 Regarding the CBA procedure, after transseptal puncture, a fourth-generation cryoballoon (Arctic Front; Medtronic) was introduced into the PV ostium over a 10-polar spiral mapping catheter (Achieve, Medtronic), and complete occlusion of the PV ostium was confirmed with contrast medium injection.…”

“…13 PVI was performed using a point-to-point technique with an Ablation Index module (Biosense Webster). 6,12,13 Regarding the CBA procedure, after transseptal puncture, a fourth-generation cryoballoon (Arctic Front; Medtronic) was introduced into the PV ostium over a 10-polar spiral mapping catheter (Achieve, Medtronic), and complete occlusion of the PV ostium was confirmed with contrast medium injection. Cryoballoon application consisted of a 180-240 s freezing with a minimum temperature of −60°C in each vein, and no additional CBA was performed after isolation.…”