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. 2025 Sep;11(9):1968-1979.
doi: 10.1016/j.jacep.2025.04.023. Epub 2025 Jun 11.

Peri-Atrial Adipose Tissue Inflammation in Atrial Fibrillation: Quantification of Electrophysiological Effects Using Electroanatomic Mapping

Keeran Vickneson  1 , Ali Gharaviri  1 , Vinush Vigneswaran  1 , Johanna Tonko  2 , Neil Bodagh  3 , Magdalena Klis  3 , Irum Kotadia  3 , Matthew Wright  2 , David E Newby  1 , Marc R Dweck  1 , Michelle C Williams  1 , Mark O'Neill  4 , John Whitaker  4 , Steven E Williams  5
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Free article

Peri-Atrial Adipose Tissue Inflammation in Atrial Fibrillation: Quantification of Electrophysiological Effects Using Electroanatomic Mapping

Keeran Vickneson et al. JACC Clin Electrophysiol. 2025 Sep.
Free article

Abstract

Background: Peri-atrial adipose tissue is associated with atrial fibrillation (AF). Increased peri-atrial adipose volume and attenuation, detected by cardiac computed tomography angiography (CTA), have been observed in patients with AF. However, the electrophysiological correlates of both peri-atrial adipose tissue volume and attenuation are unknown.

Objectives: This study sought to investigate the spatial relationship between peri-atrial adipose tissue, peri-atrial adipose tissue attenuation, and atrial electrophysiological remodeling.

Methods: Cardiac CTA was performed in 37 control subjects and 44 patients with AF. Left atrial bipolar voltage and conduction velocity were co-registered with cardiac CTA-derived peri-atrial adipose tissue segmentations. Mean adipose tissue volume and attenuation were compared with local voltage and conduction velocity measurements.

Results: Peri-atrial adipose tissue volume was greater in patients with AF (20.9 cm3 vs 14.2 cm3; adjusted odds ratio: 1.11; 95% CI: 1.01-1.24), independent of left atrial volume indexed to body mass index, left atrial mass, age, sex, sleep apnea, and coronary heart disease. In patients with AF, areas with the highest burden of peri-atrial adipose tissue had lower voltage (1.75 ± 1.72 mV vs 2.11 ± 2.02 mV; P < 0.001) and conduction velocity (0.627 ± 0.55 ms-1 vs 0.683 ± 0.48 ms-1; P < 0.001), compared with areas with the lowest burden of peri-atrial adipose tissue. Mean peri-atrial adipose tissue attenuation was similar in both groups. In patients with AF, low peri-atrial adipose tissue attenuation was weakly correlated with reduced bipolar voltage (1.69 ± 1.68 mV vs 2.16 ± 2.07 mV; P < 0.001) and conduction velocity (0.615 ± 0.47 ms-1 vs 0.684 ± 0.43 ms-1; P < 0.001).

Conclusions: Peri-atrial adipose tissue volume was greater in patients with AF. Increased peri-atrial adipose tissue burden and reduced attenuation were spatially but weakly correlated with adverse electrophysiological remodeling in patients with AF.

Keywords: atrial fibrillation; attenuation; conduction velocity; peri-atrial adipose tissue; voltage mapping.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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