Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Circ Arrhythm Electrophysiol. 2012 Aug 1;5(4):676-83. doi: 10.1161/CIRCEP.112.971200. Epub 2012 Jul 6.
Although increased epicardial adipose tissue (EAT) volume is known to be associated with increased prevalence of atrial fibrillation (AF), the exact mechanisms are unclear. Therefore, we investigated whether EAT locations were associated with high dominant frequency (DF) sites or complicated fractionated atrial electrogram sites during AF.
Three-dimensional reconstruction computed tomography images depicting EAT volumes (obtained by 320-detector-row multislice computed tomography) were merged with NavX-based DF and complicated fractionated atrial electrogram maps obtained during AF for 16 patients with paroxysmal AF and for 18 patients with persistent AF. Agreement between locations of the EAT, especially EAT surrounding the left atrium, and of high DF or complicated fractionated atrial electrogram sites was quantified. In addition, serum biomarker levels were determined. EAT surrounding the left atrium volumes was significantly greater in patients with persistent AF than in patients with paroxysmal AF (52.9 cm(3) [95% CI, 44.2-61.5] versus 34.8 cm(3) [95% CI, 26.6-43.0]; P=0.007). Serum high-sensitivity C-reactive protein and interleukin-6 levels were significantly higher in persistent AF patients than in paroxysmal AF patients (median high-sensitivity C-reactive protein, 969 ng/mL [interquartile range, 307-1678] versus 320 ng/mL [interquartile range, 120-660]; P=0.008; median interleukin-6, 2.4 pg/mL [interquartile range, 1.7-3.2] versus 1.3 [interquartile range, 0.8-2.4] pg/mL; P=0.017). EAT locations were in excellent agreement with high DF sites (κ=0.77 [95% CI, 0.71-0.82]) but in poor agreement with complicated fractionated atrial electrogram sites (κ=0.22 [95% CI, 0.13-0.31]).
Increased EAT volume and elevation of inflammatory biomarkers are noted in persistent AF rather than paroxysmal AF patients. High DF sites are located adjacent to EAT sites. Thus, EAT may be involved in the maintenance of AF.
虽然已知心外膜脂肪组织（EAT）体积增加与心房颤动（AF）的患病率增加有关，但确切的机制尚不清楚。因此，我们研究了在 AF 期间，EAT 位置是否与高频（DF）部位或复杂的心房碎裂电图部位相关。
通过 320 层多排 CT 获得的 EAT 体积的三维重建 CT 图像与基于 NavX 的 DF 和复杂的心房碎裂电图图合并，用于 16 例阵发性 AF 患者和 18 例持续性 AF 患者。定量分析 EAT （尤其是围绕左心房的 EAT）与高 DF 或复杂的心房碎裂电图部位的位置之间的一致性。此外，还测定了血清生物标志物水平。持续性 AF 患者的左心房周围 EAT 体积明显大于阵发性 AF 患者（52.9cm³[95%CI，44.2-61.5] vs. 34.8cm³[95%CI，26.6-43.0]；P=0.007）。持续性 AF 患者的血清高敏 C 反应蛋白和白细胞介素 6 水平明显高于阵发性 AF 患者（中位数高敏 C 反应蛋白，969ng/ml[四分位距，307-1678] vs. 320ng/ml[四分位距，120-660]；P=0.008；中位数白细胞介素 6，2.4pg/ml[四分位距，1.7-3.2] vs. 1.3[四分位距，0.8-2.4]pg/ml；P=0.017）。EAT 位置与高频 DF 部位具有很好的一致性（κ=0.77[95%CI，0.71-0.82]），但与复杂的心房碎裂电图部位的一致性较差（κ=0.22[95%CI，0.13-0.31]）。
持续性 AF 患者而非阵发性 AF 患者中，EAT 体积增加和炎症标志物升高。高频 DF 部位位于 EAT 部位附近。因此，EAT 可能参与 AF 的维持。
