Adipose tissue volume and atrial fibrosis fraction jointly predicted the number of reentry-attracting locations in 22 patients with persistent atrial fibrillation.
Does the assessment of three-dimensional fibrosis distribution and atrial adiposity predict electrophysiological abnormalities in patients with persistent atrial fibrillation?
Atrial adiposity and three-dimensional fibrosis distribution interact to influence the arrhythmogenic substrate in persistent atrial fibrillation.
Absolute Event Rate: 0% vs 0%
Abstract Aims Persistent atrial fibrillation (PsAF) is often refractory to pulmonary vein isolation, a well-established AF treatment, owing to the fibrosis-remodeled substrates sustaining reentries. Three-dimensional fibrosis distribution and atrial adiposity have been found to be essential contributors to PsAF arrhythmogenesis. We aimed to utilize late gadolinium enhancement (LGE)-MRI-derived personalized heart digital twins (DTs)—a recent promising tool for non-invasively assessing patient arrhythmogenesis—as well as contrast-enhanced cardiac computed tomography (CCT) images and electroanatomic maps (EAMs) to investigate relationships between fibrosis distribution, including endo–epi differences, adiposity infiltration, and electrophysiological abnormalities, and their influence on PsAF arrhythmogenic substrate. Methods and results DTs incorporating fibrosis distribution were generated from consecutive PsAF patients’ LGE-MRIs. Using rapid pacing, potential locations attracting reentries (LRs) were identified in DTs. CCTs were used to segment adipose tissue within pericardial sac and evaluate the distance from endocardial surface to closest adipose tissue (DEnCA). Bipolar- and unipolar-low-voltage area fractions (LVFs) were extracted from EAMs. Volumetric fibrosis fraction (FF) and surface FF on endocardial and epicardial surfaces at LRs and non-LRs were analyzed in relation to DEnCA and LVF. In 22 patients, adipose tissue volume correlated with BMI and CHA2DS2-VASc and, together with atrial-FF, predicted number of LRs. At LRs and non-LRs, while volumetric-FF was the sole determinant of LR classification, volumetric-FF correlated with endocardium-predominant fibrosis and bipolar-LVF. Endocardium-predominant fibrosis was independently linked to DEnCA. Conclusion This study highlights the complex interactions between structural features, such as three-dimensional fibrosis distribution and atrial adiposity infiltration, electrophysiological features, and PsAF arrhythmogenesis.
Sakata et al. (Thu,) reported a other. Adipose tissue volume and atrial fibrosis fraction jointly predicted the number of reentry-attracting locations in 22 patients with persistent atrial fibrillation.