Association between body size and atrial myopathy: Investigation using the prevalence of left atrial low-voltage areas

Figures

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  Fig. 1. Patient flowchart. Of the 2,057 patients who underwent initial AF ablation, 1,479 patients were enrolled after excluding 569 patients who did not undergo voltage mapping and 9 patients with missing height or body weight data. Patients were classified by BMI into four groups: <18.5 kg/m2, 18.5–25.0 kg/m2, 25.0–30.0 kg/m2, and ≥30.0 kg/m2. AF, atrial fibrillation; BMI, body mass index.

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  Fig. 2. Association between BMI and prevalence of LVAs A J-curve phenomenon was seen between BMI and the prevalence of LVAs. Prevalence of LVAs significantly differed among groups stratified by BMI. P values indicate significance level for the relationship between the prevalence of LVAs and groups stratified by BMI. Even on stratification by gender and AF type, the J-curved phenomenon is seen between BMI and prevalence of LVAs. The parameters of the quadratic approximation curve were y = 0.001x2-0.076x+1.312, R2 = 0.019, p < 0.001 (all); y = 0.001x2-0.035x+0.664, R2 = 0.005, p = 0.10 (male); y = 0.001x2-0.059x+1.237, R2 = 0.015, p = 0.02 (female); y = 0.001x2-0.042x+0.781, R2 = 0.014, p = 0.02 (paroxysmal AF) and y = 0.002x2-0.12x+1.996, R2 = 0.035, p < 0.001 (persistent AF). BMI, body mass index; LVAs, left atrial low-voltage areas, AF, atrial fibrillation.

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  Fig. 3. Association between height or body weight and prevalence of LVAs A J-curve phenomenon was seen between body weight and the prevalence of LVAs. In contrast, the prevalence of LVAs increased with decreasing height. The parameters of the quadratic approximation curve in body weight were y = 0.0002x2-0.029x+1.435, R2 = 0.070, p < 0.001 (all); y = 0.00006x2-0.012x+0.721, R2 = 0.014, p = 0.001 (male) and y = 0.0002x2-0.029x+1.439, R2 = 0.037, p < 0.001 (female). The parameters of the quadratic approximation curve in height were y = 0.0001x2-0.054x+5.621, R2 = 0.082, p < 0.001 (all); y = −0.0001x2+0.034x-2.046, R2 = 0.019, p < 0.001 (male) and y = −0.0002x2+0.50x-2.451, R2 = 0.029, p = 0.001 (female). LVAs, left atrial low-voltage areas.

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  Fig. 4. Rhythm outcome following AF ablation in patients stratified by BMI Freedom from AF recurrence significantly differed among groups stratified by BMI. In particular, freedom from AF recurrence was significantly lower in patients with BMI <18.5 kg/m2 or BMI ≥30.0 kg/m2 than in those with 18.5–25.0 kg/m2. AF, atrial fibrillation; BMI, body mass index.

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  Fig. 5. Rhythm outcome following AF ablation in patients with or without LVAs (A) In patients without LVAs, freedom from AF recurrence did not significantly differ among groups stratified by BMI. (B) In patients with LVAs, freedom from AF recurrence significantly differed among groups stratified by BMI. AF, atrial fibrillation; LVAs, left atrial low-voltage areas; BMI, body mass index.

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  Fig. 6. Rhythm outcome following AF ablation stratified to AF type (A) In patients with paroxysmal AF, freedom from AF recurrence significantly differed among groups stratified by BMI. (B) In patients with persistentAF, freedom from AF recurrence significantly differed among groups stratified by BMI. AF, atrial fibrillation; BMI, body mass index.

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  Fig. 7. Rhythm outcome following AF ablation in patients with paroxysmal AF (A) In patients without LVAs, freedom from AF recurrence did not significantly differ among groups stratified by BMI. (B) In patients with LVAs, freedom from AF recurrence did not significantly differ among groups stratified by BMI. AF, atrial fibrillation; LVAs, left atrial low-voltage areas; BMI, body mass index.

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  Fig. 8. Rhythm outcome following AF ablation in patients with persistent AF. (A) In patients without LVAs, freedom from AF recurrence did not significantly differ among groups stratified by BMI. (B) In patients with LVAs, freedom from AF recurrence significantly differed among groups stratified by BMI. AF, atrial fibrillation; LVAs, left atrial low-voltage areas; BMI, body mass index.