title: Pericardial fat is associated with atrial conduction: the Framingham Heart Study.
abstract: BACKGROUND
  Obesity is associated with altered atrial electrophysiology and a prominent risk factor for atrial fibrillation. Body mass index, the most widely used adiposity measure, has been related to atrial electrical remodeling. We tested the hypothesis that pericardial fat is independently associated with electrocardiographic measures of atrial conduction.
  
  
  RESULTS
  We performed a cross-sectional analysis of 1946 Framingham Heart Study participants (45% women) to determine the relation between pericardial fat and atrial conduction as measured by P wave indices (PWI): PR interval, P wave duration (P-duration), P wave amplitude (P-amplitude), P wave area (P-area), and P wave terminal force (P-terminal). We performed sex-stratified linear regression analyses adjusted for relevant clinical variables and ectopic fat depots. Each 1-SD increase in pericardial fat was significantly associated with PR interval (β=1.7 ms, P=0.049), P-duration (β=2.3 ms, P<0.001), and P-terminal (β=297 μV·ms, P<0.001) among women; and P-duration (β=1.2 ms, P=0.002), P-amplitude (β=-2.5 μV, P<0. 001), and P-terminal (β=160 μV·ms, P=0.002) among men. Among both sexes, pericardial fat was significantly associated with P-duration in analyses additionally adjusting for visceral fat or intrathoracic fat; a similar but non-significant trend existed with P-terminal. Among women, pericardial fat was significantly associated with P wave area after adjustment for visceral and intrathoracic fat.
  
  
  CONCLUSIONS
  Pericardial fat is associated with atrial conduction as quantified by PWI, even with adjustment for extracardiac fat depots. Further studies are warranted to identify the mechanisms through which pericardial fat may modify atrial electrophysiology and promote subsequent risk for arrhythmogenesis.
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Friedman
authors.forename: Na
authors.initials: N
authors.lastname: Wang
authors.forename: James B
authors.initials: JB
authors.lastname: Meigs
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Massaro
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
authors.forename: Jared W
authors.initials: JW
authors.lastname: Magnani
mesh_terms: D050154:Adiposity; D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology; D016275:Atrial Function; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D016014:Linear Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D010496:Pericardium / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors
keywords: atrium; conduction; electrocardiography; epidemiology; obesity