{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:35:39Z","timestamp":1788244539289,"version":"build-2803163510"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T00:00:00Z","timestamp":1648425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Although in persistent atrial fibrillation (AF) a complex AF substrate characterized by a high incidence of conduction block has been reported, relatively little is known about AF complexity in paroxysmal AF (pAF). Also, the relative contribution of various aspects of structural alterations to conduction disturbances is not clear. In particular, the contribution of endomysial fibrosis to conduction disturbances during progression of AF has not been studied yet.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>During cardiac surgery, epicardial high-density mapping was performed in patients with acutely induced (aAF, n = 11), pAF (n = 12), and longstanding persistent AF (persAF, n = 9) on the right atrial (RA) wall, the posterior left atrial wall (pLA) and the LA appendage (LAA). In RA appendages, overall and endomysial (myocyte-to-myocyte distances) fibrosis and connexin 43 (Cx43) distribution were quantified. Unipolar AF electrogram analysis showed a more complex pattern with a larger number of narrower waves, more breakthroughs and a higher fractionation index (FI) in persAF compared with aAF and pAF, with no differences between aAF and pAF. The FI was consistently higher at the pLA compared with the RA. Structurally, Cx43 lateralization increased with AF progression (aAF = 7.5 \u00b1 8.9%, pAF = 24.7 \u00b1 11.1%, persAF = 35.1 \u00b1 11.4%, P &amp;lt; 0.001). Endomysial but not overall fibrosis correlated with AF complexity (r = 0.57, P = 0.001; r = 0.23, P = 0.20; respectively).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Atrial fibrillation complexity is highly variable in patients with pAF, but not significantly higher than in patients with acutely induced AF, while in patients with persistent AF complexity is higher. Among the structural alterations studied, endomysial fibrosis, but not overall fibrosis, is the strongest determinant of AF complexity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euac026","type":"journal-article","created":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T20:15:15Z","timestamp":1647375315000},"page":"1015-1024","source":"Crossref","is-referenced-by-count":38,"title":["Endomysial fibrosis, rather than overall connective tissue content, is the main determinant of conduction disturbances in human atrial fibrillation"],"prefix":"10.1093","volume":"24","author":[{"given":"Bart","family":"Maesen","sequence":"first","affiliation":[{"name":"Department of Cardio-Thoracic Surgery, Maastricht University Medical Center , Maastricht , The Netherlands"},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , The 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Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Nijs","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, UZ Brussels , Brussels , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stijn","family":"Lumeij","sequence":"additional","affiliation":[{"name":"Department of Physiology, Maastricht University , Universiteitssingel 50, PO Box 616, 6200MD Maastricht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis H","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Physiology, Maastricht University , Universiteitssingel 50, PO Box 616, 6200MD Maastricht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Granier","sequence":"additional","affiliation":[{"name":"Department of Physiology, Maastricht University , Universiteitssingel 50, PO Box 616, 6200MD Maastricht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry Jgm","family":"Crijns","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , The Netherlands"},{"name":"Department of Cardiology, Maastricht University Medical Center , Maastricht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos G","family":"Maessen","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic Surgery, Maastricht University Medical Center , Maastricht , The Netherlands"},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Dhein","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Clinic for Cardiac Surgery, Heart Centre Leipzig , Leipzig , 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