Catheter Ablation for Atrial Fibrillation in Patients With Obesity

Abstract

Background-Obesity is a risk factor for atrial fibrillation and other cardiovascular conditions. Our objective was to determine whether catheter-based ablation effectively treated atrial fibrillation in obese patients. Methods and Results-Five hundred twenty-three consecutive patients with symptomatic, medication-refractory atrial fibrillation underwent catheter ablation. Patients were grouped by body mass index (lean, Ͻ25 kg/m 2 ; overweight, 25 to 29.9 kg/m 2 ; obese, Ն30 kg/m 2 ). Outcome and quality of life were measured with a general health survey (Medical Outcomes Study 36-item Short-Form General Health Survey ); patients were assessed before ablation and at 3 and 12 months after the procedure. Two hundred twenty-eight study patients (44%) were overweight, and 201 (38%) were obese. Twelve months after curative ablation, 72% of patients were free of atrial fibrillation without the use of antiarrhythmic agents; 84% were arrhythmia free when those receiving medication were included. Atrial fibrillation was eliminated in 75%, 72%, and 70% of the lean, overweight, and obese patients, respectively, at 12 months (Pϭ0.41, trend test). SF-36 scores were lower for patients with higher body mass index (PϽ0.05) at baseline. SF-36 scores improved in every functional domain for all body mass index groups after ablation. The mean SF-36 total physical score increased from 59Ϯ20 at baseline to 77Ϯ19 in 12 months (PϽ0.001). The total mental health score improved from 66Ϯ18 to 79Ϯ16 in 12 months (PϽ0.001). Conclusions-Catheter

Metabolic Syndrome and Catheter Ablation in Atrial Fibrillation

“…Although the LA enlargement that is usually present in obese patients seems to work as a facilitating factor in AF recurrence, Cha et al found that AF catheter ablation was similarly effective in obese patients, 4 which was in good accordance with the study of Tang et al 1 In the latter study, AF recurrence mostly occurred early after catheter ablation, and an electrical reconnection between the LA and PV was confirmed in most patients who underwent repeat catheter ablation. Because AF recurrence did not different between the groups with simple PV isolation or PV isolation plus substrate modification, the primary reason for AF recurrence was thought to be electrical reconnection, and the development of triggered firing from a new, non-PV focus, and/or progression of structural and electrical remodeling, seemed to play a less important role.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Otyłość może zwiększać częstość nawrotów AF po ablacji przezcewnikowej [298][299][300][301], a ważnym potencjalnym czynnikiem zakłócającym jest obturacyjny bezdech senny. Otyłość powiązano również z większą dawką promieniowania i częstością występowania powikłań podczas ablacji AF [302,303].…”

“…Otyłość powiązano również z większą dawką promieniowania i częstością występowania powikłań podczas ablacji AF [302,303]. Warto zauważyć, że poprawa objawowa po przezcewnikowej ablacji AF u otyłych pacjentów wydaje się podobna jak u pacjentów o prawidłowej masie ciała [298]. Biorąc pod uwagę potencjał zmniejszenia częstości występo-wania epizodów AF poprzez redukcję masy ciała (patrz rozdz.…”

Atrial Fibrillation Catheter Ablation: Overcoming Complications and Improving Success

“…4 Patients with increased body mass index who required prolonged time for the completion of pulmonary vein isolation (PVI) were at greater risk for the development of complications because of their comorbid conditions. 5 Additionally, mechanical issues leading to high complications, such as difficulty with endotracheal intubation, possible hemodynamic intolerance to general anesthesia, vascular access issues, and substantially higher radiation exposure, remain significant concerns to be addressed.…”