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Increased body mass index, age, and left atrial size are associated with altered intracardiac atrial electrograms in persistent atrial fibrillation patients

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Abstract

Background

There are limited studies evaluating whether atrial fibrillation (AF) patients with increased BMI, age, and left atrial (LA) size have altered intracardiac electrogram (EGM) morphology.

Methods

We analyzed left atrial intracardiac EGMs acquired during invasive electrophysiology study in 54 patients with AF. EGM correlations were assessed among AF risk factors including age, left atrial size, and BMI.

Results

BMI correlated positively with DF (r2 = 0.17, p = 0.009) and MP (r2 = 0.16, p = 0.01) with dominant frequency (DF) and mean spectral profile (MP) greater among obese individuals. Age was negatively associated with mean amplitude (r2 = 0.42, p < 0.001) and width (r2 = 0.32, p < 0.001); age was positively correlated with MP (r2 = 0.24, p < 0.001). LA size was negatively correlated with mean amplitude (r2 = 0.18, p = 0.03) and width (r2 = 0.23, p = 0.01); LA size was positively correlated with DF (r2 = 0.22, p = 0.01) and MP (r2 = 0.23, p = 0.01). Mean amplitude and width were decreased among subjects with a severely enlarged LA; DF and MP were increased in those with severely enlarged LA. The associations with BMI and LA size remained significant in multiple regression models that included age, male gender, time since AF diagnosis, and LVEF.

Conclusions

EGM morphology of AF patients with increased BMI, older age, and an enlarged LA possessed decreased amplitude and decreased width and increased DF and MP. These findings suggest that atrial remodeling due to increased age, LA size, and BMI is associated with differences in local atrial activation, decreased refractoriness, and more heterogeneous activation. These novel findings point out clinical risk factors for atrial fibrillation that may affect electrogram characteristics.

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Data availability

Data available upon request.

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Authors and Affiliations

  1. Internal Medicine, Division of Cardiology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA

    Isaac L. Goldenthal, Edward J. Ciaccio, Robert R. Sciacca, Hasan Garan & Angelo B. Biviano

  2. Columbia University Irving Medical Center, 161 Fort Washington Ave #546, New York, NY, 10032, USA

    Angelo B. Biviano

Authors
  1. Isaac L. Goldenthal
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  2. Edward J. Ciaccio
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  3. Robert R. Sciacca
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  5. Angelo B. Biviano
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Corresponding author

Correspondence to Angelo B. Biviano.

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Conflict of interest

Dr. Biviano reports serving as a medical advisory board member for Boston Scientific and Biosense Webster.

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This research was conducted with approval from the Columbia University Institutional Review Board.

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Statistical code available upon request.

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Goldenthal, I.L., Ciaccio, E.J., Sciacca, R.R. et al. Increased body mass index, age, and left atrial size are associated with altered intracardiac atrial electrograms in persistent atrial fibrillation patients. J Interv Card Electrophysiol 62, 569–577 (2021). https://doi.org/10.1007/s10840-020-00933-5

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  • DOI: https://doi.org/10.1007/s10840-020-00933-5

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