Top

Published in:

09-10-2023 | Atrial Fibrillation | Original Article

Prolonged PR intervals are associated with epicardial adipose tissue and recurrence after catheter ablation in persistent atrial fibrillation

Authors: Shunsuke Tomomori, Kazuyoshi Suenari, Akinori Sairaku, Tadanao Higaki, Kazuoki Dai, Kuniomi Oi, Tomoharu Kawase, Norihiko Ohashi, Kenji Nishioka, Yoshiko Masaoka, Nobuo Shiode, Yukiko Nakano

Published in: Heart and Vessels | Issue 3/2024

Abstract

Epicardial adipose tissue (EAT) has been reported to promote myocardial fibrosis and to affect intracardiac conduction. The PR interval reflects the conduction from the atria to the Purkinje fibers and may be associated with the EAT volume, especially in persistent atrial fibrillation (AF) patients. We aimed to investigate the relationship between the EAT and PR interval in patients with persistent AF. We enrolled 268 persistent AF patients who underwent catheter ablation (CA) and divided the patients into two groups: the normal PR interval group (PR interval less than 200 ms: Group N) and long PR interval group (PR interval 200 ms or more: Group L). We then analyzed the association between the total EAT volume around the heart and PR interval and calculated the ratio of the duration of the P wave (PWD) to the PR interval (PWD/PR interval). Moreover, we investigated whether a long PR interval was associated with the outcomes after ablation. The total EAT volume was significantly larger in Group L than Group N (Group N: 131.4 ± 51.8 ml vs. Group L: 151.3 ± 63.3 ml, p = 0.039). A positive correlation was also observed between the PWD/PR interval and EAT volume in Group L (r = 0.345, p = 0.039). A multivariate analysis also revealed that a long PR interval was independently associated with AF recurrence after CA (hazard ratio [HR] 2.071, p = 0.032). The total EAT volume was associated with a long PR interval, and a long PR interval was a significant risk factor for recurrence after ablation in persistent AF patients.

Abe I, Teshima Y, Kondo H, Kaku H, Kira S, Ikebe Y, Saito S, Fukui A, Shinohara T, Yufu K, Nakagawa M, Hijiya N, Moriyama M, Shimada T, Miyamoto S, Takahashi N (2018) Association of fibrotic remodeling and cytokines/chemokines content in epicardial adipose tissue with atrial myocardial fibrosis in patients with atrial fibrillation. Heart Rhythm 15(11):1717–1727CrossRefPubMed

Nalliah CJ, Bell JR, Raaijmakers AJA, Waddell HM, Wells SP, Bernasochi GB, Montgomery MK, Binny S, Watts T, Joshi SB, Lui E, Sim CB, Larobina M, O’Keefe M, Goldblatt J, Royse A, Lee G, Porrello ER, Watt MJ, Kistler PM, Sanders P, Delbridge LMD, Kalman JM (2020) Epicardial adipose tissue accumulation confers atrial conduction abnormality. J Am Coll Cardiol 76(10):1197–1211CrossRefPubMed

Tanaka Y, Tada H, Hamaya R, Patel RB, Hayashi K, Yamagami K, Hashiba A, Takamura M, Kawashiri MA, Greenland P (2021) First-degree atrioventricular block is significantly associated with incident atrial fibrillation in the population predominantly including participants aged ≥ 60 years. Heart Vessels 36(9):1401–1409CrossRefPubMed

Sairaku A, Nakano Y, Suenari K, Tokuyama T, Kawazoe H, Matsumura H, Tomomori S, Amioka M, Kihara Y (2016) Electrical remodeling of the atrioventricular node caused by persistent atrial fibrillation in humans. J Cardiovasc Electrophysiol 27(8):918–922CrossRefPubMed

Park J, Kim TH, Lee JS, Park JK, Uhm JS, Joung B, Lee MH, Pak HN (2014) Prolonged PR interval predicts clinical recurrence of atrial fibrillation after catheter ablation. J Am Heart Assoc 3(5):e001277CrossRefPubMedPubMedCentral

Chen J, Mei Z, Yang Y, Dai C, Wang Y, Zeng R, Liu Q (2022) Epicardial adipose tissue is associated with higher recurrence risk after catheter ablation in atrial fibrillation patients: a systematic review and meta-analysis. BMC Cardiovasc Disord 22(1):264CrossRefPubMedPubMedCentral

Mirolo A, Viart G, Savouré A, Godin B, Raitière O, Eltchaninoff H, Anselme F (2019) Epicardial fat thickness predicts atrial fibrillation recurrence after a first pulmonary vein isolation procedure using a second-generation cryoballoon. Arch Cardiovasc Dis 112(5):314–322CrossRefPubMed

Sang C, Hu X, Zhang D, Shao Y, Qiu B, Li C, Li F, Zhang C, Wang Z, Chen M (2023) The predictive value of left atrium epicardial adipose tissue on recurrence after catheter ablation in patients with different types of atrial fibrillation. Int J Cardiol 379:33–39CrossRefPubMed

Cruz I, Lopes Fernandes S, Diaz SO, Saraiva F, Barros AS, Primo J, Sampaio F, Ladeiras-Lopes R, Fontes-Carvalho R (2022) Epicardial adipose tissue volume is not an independent predictor of atrial fibrillation recurrence after catheter ablation. Rev Esp de Cardiol (Engl Ed) 76:539–547CrossRef

10.

Hammache N, Pegorer-Sfes H, Benali K, Magnin Poull I, Olivier A, Echivard M, Pace N, Minois D, Sadoul N, Mandry D, Sellal JM, de Chillou C (2021) Is there an association between epicardial adipose tissue and outcomes after paroxysmal atrial fibrillation catheter ablation? J Clin Med 10(14):3037CrossRefPubMedPubMedCentral

11.

Kitagawa T, Hattori T, Sentani K, Senoo A, Fujii Y, Takahashi S, Yasui W, Nakano Y, Kihara Y (2021) Relationship between interleukin-1β gene expression in epicardial adipose tissue and coronary atherosclerosis based on computed tomographic analysis. J Cardiovasc Comput Tomogr 15(2):175–179CrossRefPubMed

12.

Supanekar N, Gilge JL, Ahmed A, Patel PJ (2022) Post-ablation P wave characteristics correlate with recurrent atrial fibrillation in the ABCD-AF cohort. J Interv Card Electrophysiol 64(2):437–442CrossRefPubMed

13.

Nakano T, Suenari K, Okada A, Hyodo Y, Tomomori S, Higaki T, Oi K, Dai K, Kawase T, Nakama Y, Nishioka K, Otsuka M, Masaoka Y, Shiode N, Nakano Y (2022) New minimally invasive and tailor-made strategy for cryoballoon ablation in patients with paroxysmal atrial fibrillation. Heart Lung Circ 31(4):530–536CrossRefPubMed

14.

Ohguchi S, Inden Y, Yanagisawa S, Shigematsu T, Yasuda K, Katagiri K, Oguri M, Murohara T (2022) Long P-wave duration immediately after pulmonary vein isolation on radiofrequency catheter ablation for atrial fibrillation predicts clinical recurrence: correlation with atrial remodeling in persistent atrial fibrillation. Heart Vessels 37(3):476–488CrossRefPubMed

15.

Yamada S, Kaneshiro T, Nodera M, Amami K, Nehashi T, Takeishi Y (2023) Left atrial epicardial adipose tissue exacerbates electrical conduction disturbance in normal-weight patients undergoing pulmonary vein isolation for atrial fibrillation. J Cardiovasc Electrophysiol 34(3):565–574CrossRefPubMed

16.

Jhuo SJ, Hsieh TJ, Tang WH, Tsai WC, Lee KT, Yen HW, Lai WT (2018) The association of the amounts of epicardial fat, P wave duration, and PR interval in electrocardiogram. J Electrocardiol 51(4):645–651CrossRefPubMed

17.

Intzes S, Zagoridis K, Symeonidou M, Spanoudakis E, Arya A, Dinov B, Dagres N, Hindricks G, Bollmann A, Kanoupakis E, Koutalas E, Nedios S (2023) P-wave duration and atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis. Europace 25(2):450–459CrossRefPubMed

18.

Wang YS, Chen GY, Li XH, Zhou X, Li YG (2017) Prolonged P-wave duration is associated with atrial fibrillation recurrence after radiofrequency catheter ablation: a systematic review and meta-analysis. Int J Cardiol 227:355–359CrossRefPubMed

19.

Rasmussen PV, Nielsen JB, Skov MW, Pietersen A, Graff C, Lind B, Struijk JJ, Olesen MS, Haunsø S, Køber L, Svendsen JH, Holst AG (2017) Electrocardiographic PR interval duration and cardiovascular risk: results from the Copenhagen ECG study. Can J Cardiol 33(5):674–681CrossRefPubMed

20.

Zylla MM, Leiner J, Rahm AK, Hoffmann T, Lugenbiel P, Schweizer P, Scholz E, Mereles D, Kronsteiner D, Kieser M, Katus HA, Frey N, Thomas D (2022) Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction. Circ Heart Fail 15(9):e009281CrossRefPubMed

21.

Manfrin M, Mugnai G, Rauhe W, Velagic V, Unterhuber M (2021) Left atrial pressure as a predictor of success in catheter ablation of atrial fibrillation in a real-life cohort. J Clin Med 10(15):3208CrossRefPubMedPubMedCentral

22.

Schnittger I, Appleton CP, Hatle LK, Popp RL (1988) Diastolic mitral and tricuspid regurgitation by Doppler echocardiography in patients with atrioventricular block: new insight into the mechanism of atrioventricular valve closure. J Am Coll Cardiol 11(1):83–88CrossRefPubMed

Title: Prolonged PR intervals are associated with epicardial adipose tissue and recurrence after catheter ablation in persistent atrial fibrillation
Authors: Shunsuke Tomomori
Kazuyoshi Suenari
Akinori Sairaku
Tadanao Higaki
Kazuoki Dai
Kuniomi Oi
Tomoharu Kawase
Norihiko Ohashi
Kenji Nishioka
Yoshiko Masaoka
Nobuo Shiode
Yukiko Nakano
Publication date: 09-10-2023
Publisher: Springer Japan
Keyword: Atrial Fibrillation
Published in: Heart and Vessels / Issue 3/2024
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI: https://doi.org/10.1007/s00380-023-02323-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prolonged PR intervals are associated with epicardial adipose tissue and recurrence after catheter ablation in persistent atrial fibrillation

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2024

Presystolic wave as a predictor of interatrial block in patients with supraventricular tachycardia

Soluble ST2, BCN-Bio-HF calculator and MAGGIC-HF score in long-term risk prediction after an urgent visit for heart failure

Mid-term outcomes of surgical aortic valve replacement using a mosaic porcine bioprosthesis with concomitant mitral valve repair

Impact of the intra-aortic balloon pump on the reliability of the fourth-generation FloTrac/EV1000 system in patients undergoing robotic-assisted off-pump coronary artery bypass surgery

Investigation of the predictive value of a novel algorithm based on coronary CT angiography regarding fractional flow reserve and revascularization in patients with stable coronary artery disease

Treatment with catheter ablation for patients with arrhythmia-induced cardiomyopathy caused by atrial fibrillation promises a good prognosis