Contribution of fibrosis and the autonomic nervous system to atrial fibrillation electrograms in heart failure

Hemantha Koduri, Ivan Cokic, Gary L. Aistrup, David Gordon, Andrew Wasserstrom, Alan H. Kadish, Richard Lee, Rod Passman, Bradley P. Knight, Jeffrey J. Goldberger, Rishi Arora

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background-Fibrotic and autonomic remodeling in heart failure (HF) increase vulnerability to atrial fibrillation (AF). Because AF electrograms (EGMs) are thought to reflect the underlying structural substrate, we sought to (1) determine the differences in AF EGMs in normal versus HF atria and (2) assess how fibrosis and nerve-rich fat contribute to AF EGM characteristics in HF. Methods and Results-AF was induced in 20 normal dogs by vagal stimulation and in 21 HF dogs (subjected to 3 weeks of rapid ventricular pacing at 240 beats per minute). AF EGMs were analyzed for dominant frequency (DF), organization index, fractionation intervals (FIs), and Shannon entropy. In 8 HF dogs, AF EGM correlation with underlying fibrosis/fat/nerves was assessed. In HF compared with normal dogs, DF was lower and organization index/FI/Shannon entropy were greater. DF/FI were more heterogeneous in HF. Percentage fat was greater, and fibrosis and fat were more heterogeneously distributed in the posterior left atrium than in the left atrial appendage. DF/organization index correlated closely with %fibrosis. Heterogeneity of DF/FI correlated with the heterogeneity of fibrosis. Autonomic blockade caused a greater change in DF/FI/Shannon entropy in the posterior left atrium than left atrial appendage, with the decrease in Shannon entropy correlating with %fat. Conclusions-The amount and distribution of fibrosis in the HF atrium seems to contribute to slowing and increased organization of AF EGMs, whereas the nerve-rich fat in the HF posterior left atrium is positively correlated with AF EGM entropy. By allowing for improved detection of regions of dense fibrosis and high autonomic nerve density in the HF atrium, these findings may help enhance the precision and success of substrate-guided ablation for AF.

Original languageEnglish (US)
Pages (from-to)640-649
Number of pages10
JournalCirculation: Arrhythmia and Electrophysiology
Volume5
Issue number4
DOIs
StatePublished - Oct 11 2012
Externally publishedYes

Fingerprint

Cardiac Electrophysiologic Techniques
Autonomic Nervous System
Atrial Fibrillation
Fibrosis
Heart Failure
Heart Atria
Entropy
Fats
Dogs
Atrial Appendage
Autonomic Pathways

Keywords

  • Atrium
  • Fibrillation
  • Fibrosis
  • Heart failure
  • Nervous system,autonomic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Contribution of fibrosis and the autonomic nervous system to atrial fibrillation electrograms in heart failure. / Koduri, Hemantha; Cokic, Ivan; Aistrup, Gary L.; Gordon, David; Wasserstrom, Andrew; Kadish, Alan H.; Lee, Richard; Passman, Rod; Knight, Bradley P.; Goldberger, Jeffrey J.; Arora, Rishi.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 5, No. 4, 11.10.2012, p. 640-649.

Research output: Contribution to journalArticle

Koduri, H, Cokic, I, Aistrup, GL, Gordon, D, Wasserstrom, A, Kadish, AH, Lee, R, Passman, R, Knight, BP, Goldberger, JJ & Arora, R 2012, 'Contribution of fibrosis and the autonomic nervous system to atrial fibrillation electrograms in heart failure', Circulation: Arrhythmia and Electrophysiology, vol. 5, no. 4, pp. 640-649. https://doi.org/10.1161/CIRCEP.111.970095
Koduri, Hemantha ; Cokic, Ivan ; Aistrup, Gary L. ; Gordon, David ; Wasserstrom, Andrew ; Kadish, Alan H. ; Lee, Richard ; Passman, Rod ; Knight, Bradley P. ; Goldberger, Jeffrey J. ; Arora, Rishi. / Contribution of fibrosis and the autonomic nervous system to atrial fibrillation electrograms in heart failure. In: Circulation: Arrhythmia and Electrophysiology. 2012 ; Vol. 5, No. 4. pp. 640-649.
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abstract = "Background-Fibrotic and autonomic remodeling in heart failure (HF) increase vulnerability to atrial fibrillation (AF). Because AF electrograms (EGMs) are thought to reflect the underlying structural substrate, we sought to (1) determine the differences in AF EGMs in normal versus HF atria and (2) assess how fibrosis and nerve-rich fat contribute to AF EGM characteristics in HF. Methods and Results-AF was induced in 20 normal dogs by vagal stimulation and in 21 HF dogs (subjected to 3 weeks of rapid ventricular pacing at 240 beats per minute). AF EGMs were analyzed for dominant frequency (DF), organization index, fractionation intervals (FIs), and Shannon entropy. In 8 HF dogs, AF EGM correlation with underlying fibrosis/fat/nerves was assessed. In HF compared with normal dogs, DF was lower and organization index/FI/Shannon entropy were greater. DF/FI were more heterogeneous in HF. Percentage fat was greater, and fibrosis and fat were more heterogeneously distributed in the posterior left atrium than in the left atrial appendage. DF/organization index correlated closely with {\%}fibrosis. Heterogeneity of DF/FI correlated with the heterogeneity of fibrosis. Autonomic blockade caused a greater change in DF/FI/Shannon entropy in the posterior left atrium than left atrial appendage, with the decrease in Shannon entropy correlating with {\%}fat. Conclusions-The amount and distribution of fibrosis in the HF atrium seems to contribute to slowing and increased organization of AF EGMs, whereas the nerve-rich fat in the HF posterior left atrium is positively correlated with AF EGM entropy. By allowing for improved detection of regions of dense fibrosis and high autonomic nerve density in the HF atrium, these findings may help enhance the precision and success of substrate-guided ablation for AF.",
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T1 - Contribution of fibrosis and the autonomic nervous system to atrial fibrillation electrograms in heart failure

AU - Koduri, Hemantha

AU - Cokic, Ivan

AU - Aistrup, Gary L.

AU - Gordon, David

AU - Wasserstrom, Andrew

AU - Kadish, Alan H.

AU - Lee, Richard

AU - Passman, Rod

AU - Knight, Bradley P.

AU - Goldberger, Jeffrey J.

AU - Arora, Rishi

PY - 2012/10/11

Y1 - 2012/10/11

N2 - Background-Fibrotic and autonomic remodeling in heart failure (HF) increase vulnerability to atrial fibrillation (AF). Because AF electrograms (EGMs) are thought to reflect the underlying structural substrate, we sought to (1) determine the differences in AF EGMs in normal versus HF atria and (2) assess how fibrosis and nerve-rich fat contribute to AF EGM characteristics in HF. Methods and Results-AF was induced in 20 normal dogs by vagal stimulation and in 21 HF dogs (subjected to 3 weeks of rapid ventricular pacing at 240 beats per minute). AF EGMs were analyzed for dominant frequency (DF), organization index, fractionation intervals (FIs), and Shannon entropy. In 8 HF dogs, AF EGM correlation with underlying fibrosis/fat/nerves was assessed. In HF compared with normal dogs, DF was lower and organization index/FI/Shannon entropy were greater. DF/FI were more heterogeneous in HF. Percentage fat was greater, and fibrosis and fat were more heterogeneously distributed in the posterior left atrium than in the left atrial appendage. DF/organization index correlated closely with %fibrosis. Heterogeneity of DF/FI correlated with the heterogeneity of fibrosis. Autonomic blockade caused a greater change in DF/FI/Shannon entropy in the posterior left atrium than left atrial appendage, with the decrease in Shannon entropy correlating with %fat. Conclusions-The amount and distribution of fibrosis in the HF atrium seems to contribute to slowing and increased organization of AF EGMs, whereas the nerve-rich fat in the HF posterior left atrium is positively correlated with AF EGM entropy. By allowing for improved detection of regions of dense fibrosis and high autonomic nerve density in the HF atrium, these findings may help enhance the precision and success of substrate-guided ablation for AF.

AB - Background-Fibrotic and autonomic remodeling in heart failure (HF) increase vulnerability to atrial fibrillation (AF). Because AF electrograms (EGMs) are thought to reflect the underlying structural substrate, we sought to (1) determine the differences in AF EGMs in normal versus HF atria and (2) assess how fibrosis and nerve-rich fat contribute to AF EGM characteristics in HF. Methods and Results-AF was induced in 20 normal dogs by vagal stimulation and in 21 HF dogs (subjected to 3 weeks of rapid ventricular pacing at 240 beats per minute). AF EGMs were analyzed for dominant frequency (DF), organization index, fractionation intervals (FIs), and Shannon entropy. In 8 HF dogs, AF EGM correlation with underlying fibrosis/fat/nerves was assessed. In HF compared with normal dogs, DF was lower and organization index/FI/Shannon entropy were greater. DF/FI were more heterogeneous in HF. Percentage fat was greater, and fibrosis and fat were more heterogeneously distributed in the posterior left atrium than in the left atrial appendage. DF/organization index correlated closely with %fibrosis. Heterogeneity of DF/FI correlated with the heterogeneity of fibrosis. Autonomic blockade caused a greater change in DF/FI/Shannon entropy in the posterior left atrium than left atrial appendage, with the decrease in Shannon entropy correlating with %fat. Conclusions-The amount and distribution of fibrosis in the HF atrium seems to contribute to slowing and increased organization of AF EGMs, whereas the nerve-rich fat in the HF posterior left atrium is positively correlated with AF EGM entropy. By allowing for improved detection of regions of dense fibrosis and high autonomic nerve density in the HF atrium, these findings may help enhance the precision and success of substrate-guided ablation for AF.

KW - Atrium

KW - Fibrillation

KW - Fibrosis

KW - Heart failure

KW - Nervous system,autonomic

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