Low-voltage potentials contribute to postoperative atrial fibrillation development in obese patients

Corina Schram-Serban; Mathijs S. van Schie; Paul Knops; Charles Kik; Ad J.J.C. Bogers; Natasja M.S. de Groot

doi:10.1016/j.hrthm.2022.01.027

Low-voltage potentials contribute to postoperative atrial fibrillation development in obese patients

Corina Schram-Serban
, Mathijs S. van Schie
, Paul Knops
, Charles Kik
, Ad J.J.C. Bogers
, Natasja M.S. de Groot^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

7 Citations (Scopus)

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Abstract

Background: Obesity predisposes to the development of atrial fibrillation (AF); however, the pathophysiology underlying this relation is only partly understood.

Objective: As low-voltage areas are considered indicators of the arrhythmogenic substrates promoting AF, our study aimed to compare the extensiveness of atrial low-voltage areas between obese and nonobese patients by using high-resolution epicardial mapping in order to identify predilection sites of low-voltage areas.

Methods: A total of 430 patients (131 (30%) obese and 299 (70%) nonobese) were matched resulting in 212 patients (body mass index [BMI] ≥30 kg/m²: n = 106; BMI <30 kg/m²: n = 106) undergoing cardiac surgery (mean age 63 ± 11 years; 161 male). All patients underwent epicardial mapping of the right atrium, Bachmann bundle (BB), and left atrium during sinus rhythm. Low-voltage potentials were defined as potentials with peak-to-peak amplitudes below the fifth percentile of all potential amplitudes obtained from nonobese patients.

Results: Compared with nonobese patients, obese patients have potentials with lower voltages (median of medians) (4.5 mV [0.4–16.2 mV] vs 5.5 mV [0.8–18.0 mV]; P < .001), especially at BB (4.1 mV [0.4–12.3 mV] vs 6.2 mV [1.0–14.3 mV]; P < .001) and left atrium (5.1 mV [0.5–10.1 mV] vs 6.2 mV [0.8–15.9 mV]; P = .003). The percentage of low-voltage potentials was higher in obese (median 3.6% [0.0%–77.1%]) than in nonobese (median 2.3% [0.0%–57.9%]) patients (P < .001), again at BB (obese: 2.9% [0.0%–77.1%] vs nonobese: 0.9% [0.0%–42.0%]; P < .001). Percentages of low-voltage potentials correlated with incidences of conduction block (P < .001), while BMI (P = .044) and low-voltage potentials (P = .001) were independent predictors for the incidence of early postoperative AF.

Conclusion: Obesity may predispose to an overall decrease in atrial voltage and a higher percentage in low-voltage potentials. BB was a predilection area for low voltage within the atria of obese patients.

Original language	English
Pages (from-to)	710-718
Number of pages	9
Journal	Heart Rhythm
Volume	19
Issue number	5
DOIs	https://doi.org/10.1016/j.hrthm.2022.01.027
Publication status	Published - May 2022

Bibliographical note

Funding Information:
Funding Sources: This study was supported by funding grants from CVON Netherlands CardioVascular Research Initiative (914728, to Drs de Groot and Prof. Bianca J.J. Brundel), NWO-Vidi (91717339, to Dr de Groot), Biosense Webster USA (ICD 783454, to Dr de Groot), and Medical Delta (to Drs de Groot and BJJMB). This research (IIS-331 Phase 2) was conducted with financial support from the Investigator-Initiated Study Program of Biosense Webster, Inc.

Publisher Copyright:
© 2022 Heart Rhythm Society

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PIIS154752712200100XFinal published version, 1.74 MBLicence: CC BY

Cite this

@article{1107e5a1fc4a4b379b24888bc98b1dc6,

title = "Low-voltage potentials contribute to postoperative atrial fibrillation development in obese patients",

abstract = "Background: Obesity predisposes to the development of atrial fibrillation (AF); however, the pathophysiology underlying this relation is only partly understood. Objective: As low-voltage areas are considered indicators of the arrhythmogenic substrates promoting AF, our study aimed to compare the extensiveness of atrial low-voltage areas between obese and nonobese patients by using high-resolution epicardial mapping in order to identify predilection sites of low-voltage areas. Methods: A total of 430 patients (131 (30\%) obese and 299 (70\%) nonobese) were matched resulting in 212 patients (body mass index [BMI] ≥30 kg/m2: n = 106; BMI <30 kg/m2: n = 106) undergoing cardiac surgery (mean age 63 ± 11 years; 161 male). All patients underwent epicardial mapping of the right atrium, Bachmann bundle (BB), and left atrium during sinus rhythm. Low-voltage potentials were defined as potentials with peak-to-peak amplitudes below the fifth percentile of all potential amplitudes obtained from nonobese patients. Results: Compared with nonobese patients, obese patients have potentials with lower voltages (median of medians) (4.5 mV [0.4–16.2 mV] vs 5.5 mV [0.8–18.0 mV]; P < .001), especially at BB (4.1 mV [0.4–12.3 mV] vs 6.2 mV [1.0–14.3 mV]; P < .001) and left atrium (5.1 mV [0.5–10.1 mV] vs 6.2 mV [0.8–15.9 mV]; P = .003). The percentage of low-voltage potentials was higher in obese (median 3.6\% [0.0\%–77.1\%]) than in nonobese (median 2.3\% [0.0\%–57.9\%]) patients (P < .001), again at BB (obese: 2.9\% [0.0\%–77.1\%] vs nonobese: 0.9\% [0.0\%–42.0\%]; P < .001). Percentages of low-voltage potentials correlated with incidences of conduction block (P < .001), while BMI (P = .044) and low-voltage potentials (P = .001) were independent predictors for the incidence of early postoperative AF. Conclusion: Obesity may predispose to an overall decrease in atrial voltage and a higher percentage in low-voltage potentials. BB was a predilection area for low voltage within the atria of obese patients.",

author = "Corina Schram-Serban and \{van Schie\}, \{Mathijs S.\} and Paul Knops and Charles Kik and Bogers, \{Ad J.J.C.\} and \{de Groot\}, \{Natasja M.S.\}",

note = "Funding Information: Funding Sources: This study was supported by funding grants from CVON Netherlands CardioVascular Research Initiative (914728, to Drs de Groot and Prof. Bianca J.J. Brundel), NWO-Vidi (91717339, to Dr de Groot), Biosense Webster USA (ICD 783454, to Dr de Groot), and Medical Delta (to Drs de Groot and BJJMB). This research (IIS-331 Phase 2) was conducted with financial support from the Investigator-Initiated Study Program of Biosense Webster, Inc. Publisher Copyright: {\textcopyright} 2022 Heart Rhythm Society",

year = "2022",

month = may,

doi = "10.1016/j.hrthm.2022.01.027",

language = "English",

volume = "19",

pages = "710--718",

journal = "Heart Rhythm",

issn = "1547-5271",

publisher = "Elsevier",

number = "5",

}

TY - JOUR

T1 - Low-voltage potentials contribute to postoperative atrial fibrillation development in obese patients

AU - Schram-Serban, Corina

AU - van Schie, Mathijs S.

AU - Knops, Paul

AU - Kik, Charles

AU - Bogers, Ad J.J.C.

AU - de Groot, Natasja M.S.

N1 - Funding Information: Funding Sources: This study was supported by funding grants from CVON Netherlands CardioVascular Research Initiative (914728, to Drs de Groot and Prof. Bianca J.J. Brundel), NWO-Vidi (91717339, to Dr de Groot), Biosense Webster USA (ICD 783454, to Dr de Groot), and Medical Delta (to Drs de Groot and BJJMB). This research (IIS-331 Phase 2) was conducted with financial support from the Investigator-Initiated Study Program of Biosense Webster, Inc. Publisher Copyright: © 2022 Heart Rhythm Society

PY - 2022/5

Y1 - 2022/5

N2 - Background: Obesity predisposes to the development of atrial fibrillation (AF); however, the pathophysiology underlying this relation is only partly understood. Objective: As low-voltage areas are considered indicators of the arrhythmogenic substrates promoting AF, our study aimed to compare the extensiveness of atrial low-voltage areas between obese and nonobese patients by using high-resolution epicardial mapping in order to identify predilection sites of low-voltage areas. Methods: A total of 430 patients (131 (30%) obese and 299 (70%) nonobese) were matched resulting in 212 patients (body mass index [BMI] ≥30 kg/m2: n = 106; BMI <30 kg/m2: n = 106) undergoing cardiac surgery (mean age 63 ± 11 years; 161 male). All patients underwent epicardial mapping of the right atrium, Bachmann bundle (BB), and left atrium during sinus rhythm. Low-voltage potentials were defined as potentials with peak-to-peak amplitudes below the fifth percentile of all potential amplitudes obtained from nonobese patients. Results: Compared with nonobese patients, obese patients have potentials with lower voltages (median of medians) (4.5 mV [0.4–16.2 mV] vs 5.5 mV [0.8–18.0 mV]; P < .001), especially at BB (4.1 mV [0.4–12.3 mV] vs 6.2 mV [1.0–14.3 mV]; P < .001) and left atrium (5.1 mV [0.5–10.1 mV] vs 6.2 mV [0.8–15.9 mV]; P = .003). The percentage of low-voltage potentials was higher in obese (median 3.6% [0.0%–77.1%]) than in nonobese (median 2.3% [0.0%–57.9%]) patients (P < .001), again at BB (obese: 2.9% [0.0%–77.1%] vs nonobese: 0.9% [0.0%–42.0%]; P < .001). Percentages of low-voltage potentials correlated with incidences of conduction block (P < .001), while BMI (P = .044) and low-voltage potentials (P = .001) were independent predictors for the incidence of early postoperative AF. Conclusion: Obesity may predispose to an overall decrease in atrial voltage and a higher percentage in low-voltage potentials. BB was a predilection area for low voltage within the atria of obese patients.

AB - Background: Obesity predisposes to the development of atrial fibrillation (AF); however, the pathophysiology underlying this relation is only partly understood. Objective: As low-voltage areas are considered indicators of the arrhythmogenic substrates promoting AF, our study aimed to compare the extensiveness of atrial low-voltage areas between obese and nonobese patients by using high-resolution epicardial mapping in order to identify predilection sites of low-voltage areas. Methods: A total of 430 patients (131 (30%) obese and 299 (70%) nonobese) were matched resulting in 212 patients (body mass index [BMI] ≥30 kg/m2: n = 106; BMI <30 kg/m2: n = 106) undergoing cardiac surgery (mean age 63 ± 11 years; 161 male). All patients underwent epicardial mapping of the right atrium, Bachmann bundle (BB), and left atrium during sinus rhythm. Low-voltage potentials were defined as potentials with peak-to-peak amplitudes below the fifth percentile of all potential amplitudes obtained from nonobese patients. Results: Compared with nonobese patients, obese patients have potentials with lower voltages (median of medians) (4.5 mV [0.4–16.2 mV] vs 5.5 mV [0.8–18.0 mV]; P < .001), especially at BB (4.1 mV [0.4–12.3 mV] vs 6.2 mV [1.0–14.3 mV]; P < .001) and left atrium (5.1 mV [0.5–10.1 mV] vs 6.2 mV [0.8–15.9 mV]; P = .003). The percentage of low-voltage potentials was higher in obese (median 3.6% [0.0%–77.1%]) than in nonobese (median 2.3% [0.0%–57.9%]) patients (P < .001), again at BB (obese: 2.9% [0.0%–77.1%] vs nonobese: 0.9% [0.0%–42.0%]; P < .001). Percentages of low-voltage potentials correlated with incidences of conduction block (P < .001), while BMI (P = .044) and low-voltage potentials (P = .001) were independent predictors for the incidence of early postoperative AF. Conclusion: Obesity may predispose to an overall decrease in atrial voltage and a higher percentage in low-voltage potentials. BB was a predilection area for low voltage within the atria of obese patients.

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U2 - 10.1016/j.hrthm.2022.01.027

DO - 10.1016/j.hrthm.2022.01.027

M3 - Article

C2 - 35091122

AN - SCOPUS:85125546956

SN - 1547-5271

VL - 19

SP - 710

EP - 718

JO - Heart Rhythm

JF - Heart Rhythm

IS - 5

ER -

Low-voltage potentials contribute to postoperative atrial fibrillation development in obese patients

Abstract

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