title: Does location of epicardial adipose tissue correspond to endocardial high dominant frequency or complex fractionated atrial electrogram sites during atrial fibrillation?
abstract: BACKGROUND
  Although increased epicardial adipose tissue (EAT) volume is known to be associated with increased prevalence of atrial fibrillation (AF), the exact mechanisms are unclear. Therefore, we investigated whether EAT locations were associated with high dominant frequency (DF) sites or complicated fractionated atrial electrogram sites during AF.
  
  
  RESULTS
  Three-dimensional reconstruction computed tomography images depicting EAT volumes (obtained by 320-detector-row multislice computed tomography) were merged with NavX-based DF and complicated fractionated atrial electrogram maps obtained during AF for 16 patients with paroxysmal AF and for 18 patients with persistent AF. Agreement between locations of the EAT, especially EAT surrounding the left atrium, and of high DF or complicated fractionated atrial electrogram sites was quantified. In addition, serum biomarker levels were determined. EAT surrounding the left atrium volumes was significantly greater in patients with persistent AF than in patients with paroxysmal AF (52.9 cm(3) [95% CI, 44.2-61.5] versus 34.8 cm(3) [95% CI, 26.6-43.0]; P=0.007). Serum high-sensitivity C-reactive protein and interleukin-6 levels were significantly higher in persistent AF patients than in paroxysmal AF patients (median high-sensitivity C-reactive protein, 969 ng/mL [interquartile range, 307-1678] versus 320 ng/mL [interquartile range, 120-660]; P=0.008; median interleukin-6, 2.4 pg/mL [interquartile range, 1.7-3.2] versus 1.3 [interquartile range, 0.8-2.4] pg/mL; P=0.017). EAT locations were in excellent agreement with high DF sites (κ=0.77 [95% CI, 0.71-0.82]) but in poor agreement with complicated fractionated atrial electrogram sites (κ=0.22 [95% CI, 0.13-0.31]).
  
  
  CONCLUSIONS
  Increased EAT volume and elevation of inflammatory biomarkers are noted in persistent AF rather than paroxysmal AF patients. High DF sites are located adjacent to EAT sites. Thus, EAT may be involved in the maintenance of AF.
authors: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors: Koichi
authors: K
authors: Nagashima
authors: Yasuo
authors: Y
authors: Okumura
authors: Ichiro
authors: I
authors: Watanabe
authors: Toshiko
authors: T
authors: Nakai
authors: Kimie
authors: K
authors: Ohkubo
authors: Masayoshi
authors: M
authors: Kofune
authors: Hiroaki
authors: H
authors: Mano
authors: Kazumasa
authors: K
authors: Sonoda
authors: Takafumi
authors: T
authors: Hiro
authors: Mizuki
authors: M
authors: Nikaido
authors: Atsushi
authors: A
authors: Hirayama
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000473:pathology*; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000145:classification / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D004452:Echocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005583:Fourier Analysis; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007564:Japan; D016014:Linear Models; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000097:blood; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010496:Pericardium / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D002097:C-Reactive Protein; C522361:MMP2 protein, human; D020778:Matrix Metalloproteinase 2