Impact of Obesity on Atrial Electrophysiological Substrate

(1) Background: Obesity is a well-established worldwide recognised risk factor for atrial fibrillation (AF). Prior review papers reported on the associations between obesity and AF development, but not on the relation between obesity and atrial electrophysiology. We therefore conducted a systematic review to describe the current knowledge of the characteristics of the atrial electrophysiological substrate in obese individuals and how they relate to the development of AF.(2) Methods:A search was conducted in Pubmed, Embase, and the Cochrane Library for publications evaluating the impact of obesity on atrial electrophysiology, electrical substrates, and their relation to the development of AF. (3) Results:A systematic literature search retrieved 477 potential publications based on the inclusion criteria; 76 full-text articles were selected for the present systematic review. The literature demonstrated that obesity predisposes to not only a higher AF incidence but also to more extensive atrial electrophysiological abnormalities increasing susceptibility to AF development. (4) Conclusion:Obesity may predispose to an overall increase in atrial electropathology, consisting of an increase in the slowing of the conduction, conduction block, low-voltage areas, and complex fractionated electrograms. To determine the impact of obesity-induced atrial electrical abnormalities on the long-term clinical outcome, further prospective studies are mandatory.</p

Met de Hand op het Hartritme

Een hartritmestoornis is elke afwijkingen van het normale hartritme. Hartritmestoornissen komen steeds meer voor en hartritmestoornissen worden ook wel de cardiovasculaire epidemie van de 21e eeuw genoemd. De meest voorkomende hartritmestoornis is boezemfibrilleren, ook wel atriumfibrilleren genoemd. Tijdens deze openbare les neem ik u mee op reis door het verleden, heden en toekomst van de diagnostiek en therapie van hartritmestoornissen. Tevens laat ik u zien hoe elektrische signalen een sleutelrol spelen bij de toekomstige behandeling van hartritmestoornissen en ook hoe een trans disciplinaire samenwerking hier een bijdrage aan kan leveren

Direction- and rate-dependent fractionation during atrial fibrillation persistence: Unmasking cardiac anisotropy?

This human case is the first to illustrate morphological manifestations of direction- and rate-dependent anisotropic conduction in high-resolution unipolar atrial potentials. Premature impulses induced low-amplitude, fractionated extracellular potentials with exceptionally prolonged durations in a 76-year old longstanding persistent patient with atrial fibrillation (AF), demonstrating direction-dependency of anisotropic conduction. An increased pacing frequency induced presence of similar fractionated potentials, reflecting rate-dependent anisotropy and inhomogeneous, slow conduction. Pacing with different rates and from different sites could aid in identifying nonuniform anisotropic tissue and thus the substrate of AF