Intrinsic Cardiac Autonomic Ganglionated Plexi within Epicardial Fats Modulate the Atrial Substrate Remodeling: Experiences with Atrial Fibrillation Patients Receiving Catheter Ablation.
BACKGROUND
A recent study reported the close relationship between high dominant frequent (DF) sites [atrial fibrillation (AF) nest] and the intrinsic cardiac autonomic nervous system. The aim of this study was to investigate the correlation between the regional distribution of epicardial fat and the properties of the biatrial substrates in AF patients.


METHODS
We studied 32 patients with paroxysmal (n = 23) and persistent (n = 9) AF. The epicardial fat volume around the left atrium (LA) was evaluated using 64-slice multidetector computed tomography and the topographic distribution of the fat volume was assessed. The biatrial DFs, voltages, and total activation times (TATs) were obtained during sinus rhythm.


RESULTS
Out of the 8 divided LA regions, a significant linear correlation existed between the LA fat and mean DF values in the right upper anterior LA, left upper anterior LA, right lower anterior LA, right upper posterior LA, left upper posterior LA, and left lower posterior LA. There was no significant correlation between the regional LA fat distribution and regional LA peak-to-peak bipolar voltage and TAT. During a mean follow-up of 17 ± 8 months, 22 of the 32 (69%) patients were free of AF. In the multivariate analysis, only the mean LA DF was found to be a significant predictor of recurrence.


CONCLUSIONS
There was a close association between the regional distribution of the LA epicardial fat and the atrial substrate manifesting high frequency during sinus rhythm (AF nest). Those nests were related to ablation outcome. Hence, epicardial fat may play a significant role in atrial substrate remodeling and thereby in the pathogenesis and maintenance of AF.


BACKGROUND
Atrial fibrillation • Dominant frequency • Epicardial fat • Nest • Recurrence.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;
Rahul
R
Singhal
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei;
Li-Wei
LW
Lo
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei;
Yenn-Jiang Lin
YJ
Lin
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei;
Shih-Lin
SL
Chang
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei;
Yu-Feng
YF
Hu
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei;
Tze-Fan
TF
Chao
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei;
Fa-Po
FP
Chung
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei;
Cheun-Wang
CW
Chiou
Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei; ; National Yang-Ming University Hospital, ILan, Taiwan.
Hsuan-Ming
HM
Tsao
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei;
Shih-Ann
SA
Chen