title: Association of left atrial epicardial adipose tissue with electrogram bipolar voltage and fractionation: Electrophysiologic substrates for atrial fibrillation.
abstract: 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.
  
  
  
  The purpose of this study was to investigate the association of EAdT with adjacent myocardial substrate.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.affiliation: Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: tzghaib1@jhmi.edu.
authors.forename: Tarek
authors.initials: T
authors.lastname: Zghaib
authors.affiliation: Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Esra Gucuk
authors.initials: EG
authors.lastname: Ipek
authors.affiliation: Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Sohail
authors.initials: S
authors.lastname: Zahid
authors.affiliation: Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Muhammad Adnan
authors.initials: MA
authors.lastname: Balouch
authors.affiliation: Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Satish
authors.initials: S
authors.lastname: Misra
authors.affiliation: Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ashikaga
authors.affiliation: Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Berger
authors.affiliation: Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
authors.affiliation: Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: David D
authors.initials: DD
authors.lastname: Spragg
authors.affiliation: Department of Radiology, The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Stefan L
authors.initials: SL
authors.lastname: Zimmerman
authors.affiliation: Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Vadim
authors.initials: V
authors.lastname: Zipunnikov
authors.affiliation: Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Natalia
authors.initials: N
authors.lastname: Trayanova
authors.affiliation: Department of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.affiliation: 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.
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000294:innervation / Q000378:metabolism / Q000503:physiopathology; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis*; D015992:Body Mass Index; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D010496:Pericardium / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Arrhythmias; Atrial fibrillation; Bipolar voltage; Computerized tomography; Epicardial adipose tissue; Fibrosis; Signal fractionation