{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T15:04:19Z","timestamp":1789311859926,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Electrogram peak\u2010to\u2010peak voltage depends on atrial wall structure and mapping configuration. We evaluated the relationship between computed tomography\u2013derived atrial wall thickness, intramyocardial fat, myocardial muscle thickness, and electrogram voltage obtained with omnipolar, bipolar, and unipolar mapping.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive patients undergoing left atrial mapping during atrial fibrillation or atypical atrial flutter ablation were retrospectively included. Pre\u2010procedural contrast\u2010enhanced CT was processed with ADAS 3D to quantify left atrial wall thickness and intramyocardial fat infiltration, from which myocardial muscle thickness was derived. High\u2010density electroanatomical maps were spatially co\u2010registered with CT. Associations between anatomical parameters and peak\u2010to\u2010peak voltage were assessed, stratifying by rhythm stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty patients were included. In stable rhythms, left atrial wall thickness correlated positively with voltage for all configurations, strongest for unipolar (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.38) and omnipolar (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.23) vs. bipolar mapping (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.13) (BP\u2013UP\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001; BP\u2013OT\n                      <jats:italic>p<\/jats:italic>\n                      &lt;\u20090.01). Intramyocardial fat showed the strongest inverse association with omnipolar (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u20130.39), compared with bipolar (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u20130.14) and unipolar (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u20130.01;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2264\u20090.02). After excluding fat, muscle thickness correlated positively with OT (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.30) and UP (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.30), exceeding BP (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.14;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). In unstable rhythms, associations were attenuated but OT remained most responsive to fat (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u20130.20) and muscle thickness (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.11) (both\n                      <jats:italic>p<\/jats:italic>\n                      &lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Myocardial muscle thickness is the main determinant of local atrial voltage, while intramyocardial fat contributes to voltage attenuation. OT provides the most consistent assessment of atrial wall composition, particularly under rhythm instability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70491","type":"journal-article","created":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T14:35:12Z","timestamp":1789310112000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anatomical Determinants of the Left Atrial Electrograms: Wall Thickness and Myocardial Fat Infiltration"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5011-9687","authenticated-orcid":false,"given":"Cecilia","family":"Granata","sequence":"first","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5985-4081","authenticated-orcid":false,"given":"Nicola","family":"Pierucci","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"},{"name":"Department of Cardiovascular, Respiratory, Nephrological Aenesthesiological and Geriatric Sciences \u201cSapienza\u201d University of Rome Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Mazzocchi","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8824-4868","authenticated-orcid":false,"given":"Raimondo","family":"Pittorru","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"},{"name":"Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova Padova Italy"},{"name":"PhD Program in Translation Specialistic Medicine \u201cG.B. Morgagni\u201d, Curriculum \u201cCardiovascular Sciences\u201d Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Borras","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4696-7722","authenticated-orcid":false,"given":"Jean\u2010Baptiste","family":"Guichard","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid Spain"},{"name":"National Heart and Lung Institute, Hammersmith Campus, Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6864-9372","authenticated-orcid":false,"given":"Mariona","family":"Regany\u2010Closa","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4871-548X","authenticated-orcid":false,"given":"Jana","family":"Reventos\u2010Presmanes","sequence":"additional","affiliation":[{"name":"Corify Care, S.L"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laia","family":"Llorca","sequence":"additional","affiliation":[{"name":"Abbott Medical"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5980-2508","authenticated-orcid":false,"given":"Rosa Maria Figueras i","family":"Ventura","sequence":"additional","affiliation":[{"name":"Adas3D Medical, S.L"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1215-3472","authenticated-orcid":false,"given":"Jose Maria","family":"Tolosana","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3539-6917","authenticated-orcid":false,"given":"Adelina","family":"Doltra","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Prat","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5109-4463","authenticated-orcid":false,"given":"Blanca","family":"Domenech\u2010Ximenos","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosario Jesus","family":"Perea\u2010Palazon","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3289-2985","authenticated-orcid":false,"given":"Till","family":"Althoff","sequence":"additional","affiliation":[{"name":"German Heart Center of the Charit\u00e9, Department of Cardiology Angiology and Intensive Care Medicine, Charit\u00e9platz 1 Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8115-5906","authenticated-orcid":false,"given":"Llu\u00eds","family":"Mont","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia 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Universitat de Barcelona  Catalonia Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Garcia\u2010Alvarez","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0731-3731","authenticated-orcid":false,"given":"Ivo","family":"Roca\u2010Luque","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3510-1488","authenticated-orcid":false,"given":"Andreu","family":"Porta\u2010Sanchez","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular (ICCV), Hospital Cl\u00ednic, Universitat de Barcelona  Catalonia Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid Spain"},{"name":"Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,13]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation Developed in Collaboration With the European Association for Cardio\u2010Thoracic Surgery (EACTS)","volume":"42","author":"Hindricks G.","year":"2021","journal-title":"European Heart Journal"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euae204","article-title":"Atrial Cardiomyopathy Revisited\u2014Evolution of a Concept: A Clinical Consensus Statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS)","volume":"26","author":"Goette A.","year":"2024","journal-title":"Europace"},{"key":"e_1_2_9_4_1","first-page":"1","article-title":"Low\u2010Voltage Myocardium\u2010Guided Ablation Trial of Persistent Atrial Fibrillation","volume":"1","author":"Huo Y.","year":"2022","journal-title":"NEJM Evidence"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1093\/europace\/eux310","article-title":"Individually Tailored vs. Standardized Substrate Modification During Radiofrequency Catheter Ablation for Atrial Fibrillation: A Randomized Study","volume":"20","author":"Kircher S.","year":"2018","journal-title":"EP Europace"},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1038\/s41591-025-03674-y","article-title":"Low\u2010Voltage\u2010Area Ablation for Persistent Atrial Fibrillation: A Randomized Controlled Trial","volume":"31","author":"Masuda M.","year":"2025","journal-title":"Nature Medicine"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"e858","DOI":"10.1016\/j.hrthm.2025.05.064","article-title":"Pulmonary Vein Isolation and Low\u2010Voltage Area Ablation in Sinus Rhythm for Persistent Atrial Fibrillation: The SCAR\u2010AF Randomized Trial","volume":"22","author":"Lepillier A.","year":"2025","journal-title":"Heart Rhythm"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1001\/jama.2022.8831","article-title":"Effect of MRI\u2010Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The DECAAF II Randomized Clinical Trial","volume":"327","author":"Marrouche N. 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