Heterogeneity in Conduction Underlies Obesity-Related Atrial Fibrillation Vulnerability

Abstract

Background: Obese patients are more vulnerable to development of atrial fibrillation but pathophysiology underlying this relation is only partly understood. The aim of this study is to compare the severity and extensiveness of conduction disorders between obese patients and nonobese patients measured at a high-resolution scale. Methods: Patients (N=212) undergoing cardiac surgery (male:161, 63±11 years) underwent epicardial mapping of the right atrium, Bachmann bundle, and left atrium during sinus rhythm. Conduction delay (CD) was defined as interelectrode conduction time of 7 to 11 ms and conduction block (CB) as conduction time ≥12 ms. Prevalence of CD/CB, continuous CDCB (cCDCB), length of CD/CB/cCDCB lines, and severity of CB were analyzed. Results: In obese patients, the overall incidence of CD (3.1% versus 2.6%; P =0.002), CB (1.8% versus 1.2%; P <0.001), and cCDCB (2.6% versus 1.9%; P <0.001) was higher and CD ( P =0.012) and cCDCB ( P <0.001) lines are longer. There were more conduction disorders at Bachmann bundle and this area has a higher incidence of CD (4.4% versus 3.3%, P =0.002), CB (3.1% versus 1.6%, P <0.001), cCDCB (4.6% versus 2.7%, P <0.001) and longer CD ( P <0.001) or cCDCB ( P =0.017) lines. The severity of CB is also higher, particularly in the Bachmann bundle ( P =0.008) and pulmonary vein ( P =0.020) areas. In addition, obese patients have a higher incidence of early de-novo postoperative atrial fibrillation ( P =0.003). Body mass index ( P =0.037) and the overall amount of CB ( P =0.012) were independent predictors for incidence of early postoperative atrial fibrillation. Conclusions: Compared with nonobese patients, obese patients have higher incidences of conduction disorders, which are also more extensive and more severe. These differences in heterogeneity in conduction are already present during sinus rhythm and may explain the higher vulnerability to atrial fibrillation of obese patients.