Low-voltage potentials contribute to postoperative atrial fibrillation development in obese patients

Obesity predisposes to the development of atrial fibrillation (AF); however, the pathophysiology underlying this relation is only partly understood.

As low-voltage areas are considered indicators of the arrhythmogenic substrates promoting AF, our study aimed to compare the extensiveness of atrial low-voltage areas between obese and nonobese patients by using high-resolution epicardial mapping in order to identify predilection sites of low-voltage areas.

A total of 430 patients (131 (30%) obese and 299 (70%) nonobese) were matched resulting in 212 patients (body mass index [BMI] ≥30 kg/m²: n = 106; BMI <30 kg/m²: n = 106) undergoing cardiac surgery (mean age 63 ± 11 years; 161 male). All patients underwent epicardial mapping of the right atrium, Bachmann bundle (BB), and left atrium during sinus rhythm. Low-voltage potentials were defined as potentials with peak-to-peak amplitudes below the fifth percentile of all potential amplitudes obtained from nonobese patients.

Compared with nonobese patients, obese patients have potentials with lower voltages (median of medians) (4.5 mV [0.4-16.2 mV] vs 5.5 mV [0.8-18.0 mV]; P < .001), especially at BB (4.1 mV [0.4-12.3 mV] vs 6.2 mV [1.0-14.3 mV]; P < .001) and left atrium (5.1 mV [0.5-10.1 mV] vs 6.2 mV [0.8-15.9 mV]; P = .003). The percentage of low-voltage potentials was higher in obese (median 3.6% [0.0%-77.1%]) than in nonobese (median 2.3% [0.0%-57.9%]) patients (P < .001), again at BB (obese: 2.9% [0.0%-77.1%] vs nonobese: 0.9% [0.0%-42.0%]; P < .001). Percentages of low-voltage potentials correlated with incidences of conduction block (P < .001), while BMI (P = .044) and low-voltage potentials (P = .001) were independent predictors for the incidence of early postoperative AF.

Obesity may predispose to an overall decrease in atrial voltage and a higher percentage in low-voltage potentials. BB was a predilection area for low voltage within the atria of obese patients.