Association between oxidative balance status and left atrial substrate assessed by 3D ultra-high-density mapping
R Albarran-Rincon, P Ramos Ardanaz, M Alegre-Antelo, L Goni, M A Martinez Gonzalez, I Garcia-Bolao, M Ruiz-CanelaAbstract
Background
The association between lifestyle-related oxidative status and risk of recurrent atrial fibrillation (AF) after catheter ablation remains unknown. Left Atrial Fibrosis (LAFi) is considered a prognostic marker in patients with AF, and the left atrial mean voltage (LAmV) may serve as a surrogate for atrial tissue health and structural characterization. It is well-known that atrial fibrosis may be accelerated by oxidative stress. Previously, an oxidative balance score (OBS) was proposed as a combined measure of multiples pro- and antioxidant exposures to study the effect on chronic disease (Fig. 1). Nevertheless, the effect of OBS on LAFi has not been previously studied.
Purpose
To analyze the association between OBS and LAmV obtained by three-dimensional ultra-high-density mapping (3D-UHDM).
Methods
We included patients with symptomatic paroxysmal or persistent AF from one center of the PREDIMAR (PREvención con Dieta Mediterránea de Arrimias Recurrentes) study, a randomized trial designed to evaluate the effect of a Mediterranean diet on the recurrence of AF in patients who had undergone catheter ablation. The OBS was calculated at baseline, as a continuous variable and in tertiles according to their score. Bipolar voltage mapping was obtained in all cases using 3D-UHDM. Multivariable-adjusted linear regression models were used to assess the association of OBS and LAmV.
Results
A total of 121 patients (mean [SD] age 63.4 [11.1] years; 99 [81.8%] male) were included in the analysis. Participants in the highest OBS tertile (>27 points) were more likely to have lower rates of hypertension, better BMI and a diagnosis of paroxysmal AF. A higher LAmV was correlated with a higher OBS value. Multivariable-adjusted models showed a statistically significant increase in LAmV across successive OBS terciles (Fig. 2). In patients younger than 65 years,stratified analysis revealed an inverse statistically significant association between OBS and LAFi.
Conclusions
In patients with AF, a higher anti-oxidative score related to lifestyle was associated with higher LAmV, suggesting less LAFi. This association was particularly strong among those younger than 65 years old.