Human Tissue Analysis of Left Atrial Adipose Tissue and Atrial Fibrillation after Cox Maze Procedure
Abstract
:1. Introduction
2. Material and Methods
2.1. Patient Population and Data Collection
2.2. Surgical Procedure
2.3. Pathological Analysis of Adipose Tissue
2.4. Postoperative Rhythm Follow-Up
2.5. Data Analysis
3. Results
3.1. Perioperative Characteristics
3.2. Operative Outcomes
3.3. Effects of Late Rhythm Outcomes and Adipose Component on AF Recurrence
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | N = 115 |
---|---|
Age, years | 60.49 ± 10.49 |
Male | 56 (35%) |
AF duration, months | 41.02 ± 67.01 |
AF type | |
Paroxysmal | 21 (13.1%) |
Persistent | 70 (43.8%) |
Long-standing | 69 (43.1%) |
Body mass index, kg/m2 | 23.60 ± 3.26 |
Smoking | 151 (94.4%) |
Hypertension | 104 (65%) |
Diabetes mellitus | 33 (20.6%) |
Chronic kidney disease | 9 (5.6%) |
Stroke history | 41 (25.6%) |
Peripheral vascular disease | 3 (1.9%) |
Coronary artery disease | 21 (13.3%) |
Preoperative RF ablation | 6 (3.8%) |
Cholesterol, mg/dL | 169.18 ± 36.280 |
LDL cholesterol, mg/dL | 97.46 ± 31.597 |
HDL cholesterol, mg/dL | 43.41 ± 10.707 |
Triglyceride, mg/dL | 119.11 ± 64.394 |
Variables | N = 115 |
---|---|
Concomitant surgery | |
Aortic valve replacement | 48 (30%) |
Mitral valve repair or replacement | 148 (92.5%) |
Tricuspid annuloplasty | 122 (76.3%) |
Type of maze | |
Left atrium only | 10 (6.3%) |
Left and right atrium | 150 (93.8%) |
Ejection fraction, % | |
Preoperative | 59.53 ± 11.38 |
Postoperative | 58.71 ± 8.79 |
Left atrial volume index, mL/m2 | |
Preoperative | 101.04 ± 46.63 |
Postoperative | 73.89 ± 30.83 |
ICU stay, days | 3.38 ± 6.19 |
Hospitalization period, days | 13.92 ± 12.14 |
RF ablation for AF recurrence | 9 (7.8%) |
Permanent pacemaker insertion | 7 (6.1%) |
Variables | No Recurrence (n = 83) | Recurrence (n = 32) | p Value |
---|---|---|---|
Age, years | 57.59 ± 10.49 | 61.78 ± 10.19 | 0.055 |
Male | 27 (32.5%) | 9 (28.1%) | 0.648 |
Body mass index, kg/m2 | 23.78 ± 3.09 | 23.52 ± 3.29 | 0.686 |
AF type | 0.240 | ||
Paroxysmal | 14 (16.9%) | 3 (9.4%) | |
Persistent | 41 (49.4%) | 13 (40.6%) | |
Long-standing | 28 (33.7%) | 16 (50.0%) | |
Smoking | 80 (96.4%) | 29 (90.6%) | 0.346 |
Hypertension | 57 (68.7%) | 21 (65.6%) | 0.754 |
Diabetes mellitus | 16 (19.3%) | 6 (18.8%) | 0.949 |
Chronic kidney disease | 2 (2.4%) | 2 (6.3%) | 0.309 |
CVA history | 17 (20.5%) | 8 (25.0%) | 0.599 |
Coronary artery disease | 9 (10.8%) | 2 (6.3%) | 0.725 |
Total cholesterol, mg/dL | 172.80 ± 35.918 | 159.91 ± 36.102 | 0.088 |
LDL cholesterol, mg/dL | 99.70 ± 30.851 | 82.10 ± 33.211 | 0.263 |
HDL cholesterol, mg/dL | 43.41 ± 11.275 | 43.42 ± 9.387 | 0.995 |
Triglyceride, mg/dL | 124.19 ± 72.452 | 107.00 ± 37.236 | 0.113 |
Adipose tissue, % | 9.48 ± 10.79 | 16.17 ± 14.32 | 0.021 |
Fibrosis, % | 5.08 ± 9.19 | 5.656 ± 9.81 | 0.770 |
Type of maze | 0.671 | ||
LA only | 6 (7.2%) | 1 (3.1%) | |
Both atriums | 77 (92.8%) | 31 (96.9%) | |
Ejection fraction, % | 59.06 ± 11.28 | 60.84 ± 13.59 | 0.849 |
LAVI, mL/m2 | 93.45 ± 33.42 | 96.80 ± 33.67 | 0.641 |
Variables | Univariate | Multivariate | ||
---|---|---|---|---|
HR (95% CI) | p Value | HR (95% CI) | p Value | |
Female | 1.436 (0.641–3.217) | 0.380 | ||
Age, per year | 1.055 (1.015–1.096) | 0.007 | 1.045 (1.005–1.087) | 0.026 |
Persistent vs. paroxysmal | 1.219 (0.346–4.297) | 0.758 | ||
Long-standing vs. paroxysmal | 2.112 (0.605–7.373) | 0.241 | ||
Body mass index, per kg/m2 | 1.063 (0.940–1.201) | 0.329 | ||
Smoking | 4.834 (0.566–41.253) | 0.150 | ||
Hypertension | 0.850 (0.399–1.814) | 0.675 | ||
Diabetes mellitus | 0.886 (0.360–2.178) | 0.792 | ||
Chronic kidney disease | 2.680 (0.628–11.442) | 0.183 | ||
CVA history | 0.166 (0.730–3.755) | 0.227 | ||
Coronary artery disease | 0.583 (0.139–2.457) | 0.463 | ||
Total cholesterol, per mg/dL | 0.994 (0.984–1.004) | 0.240 | ||
LDL cholesterol, per mg/dL | 0.996 (0.984–1.007) | 0.444 | ||
HDL cholesterol, per mg/dL | 0.994 (0.963–1.027) | 0.726 | ||
Triglyceride, per mg/dL | 0.997 (0.990–1.004) | 0.358 | ||
Adipose tissue | 1.045 (1.021–1.070) | <0.001 | 1.046 (1.021–1.071) | <0.001 |
Fibrosis | 1.016 (0.984–1.048) | 0.336 | ||
AVR | 1.487 (0.656–3.373) | 0.342 | ||
MVR or MVP | 1.195 (0.161–8.847) | 0.862 | ||
TAP | 0.687 (0.305–1.550) | 0.366 | ||
Maze type | ||||
LA only vs. both atriums | 1.869 (0.251–13.940) | 0.542 | ||
Ejection fraction, per % | 1.003 (0.973–1.033) | 0.865 | ||
LAVI, per ml/m2 | 1.005 (0.994–1.016) | 0.396 |
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Kim, J.-H.; Song, J.-Y.; Shim, H.-S.; Lee, S.; Youn, Y.-N.; Joo, H.-C.; Yoo, K.-J.; Lee, S.-H. Human Tissue Analysis of Left Atrial Adipose Tissue and Atrial Fibrillation after Cox Maze Procedure. J. Clin. Med. 2022, 11, 826. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030826
Kim J-H, Song J-Y, Shim H-S, Lee S, Youn Y-N, Joo H-C, Yoo K-J, Lee S-H. Human Tissue Analysis of Left Atrial Adipose Tissue and Atrial Fibrillation after Cox Maze Procedure. Journal of Clinical Medicine. 2022; 11(3):826. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030826
Chicago/Turabian StyleKim, Jung-Hwan, Joon-Young Song, Hyo-Sup Shim, Sak Lee, Young-Nam Youn, Hyun-Chel Joo, Kyung-Jong Yoo, and Seung-Hyun Lee. 2022. "Human Tissue Analysis of Left Atrial Adipose Tissue and Atrial Fibrillation after Cox Maze Procedure" Journal of Clinical Medicine 11, no. 3: 826. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030826