Impact of body mass index on procedural complications, procedure duration, and radiation dose in patients with atrial fibrillation undergoing radiofrequency ablation: A systematic review and meta‐analysis

Abstract

Background: The association of body mass index (BMI) and procedure-related factors in patients with atrial fibrillation (AF) after radiofrequency ablation (RFA) is still unclear. Hypothesis: BMI is associated with increased the radiation dose, procedure duration, and procedural complications. Methods: Prospective studies assessing BMI and procedure duration, radiation dose, and procedural complications in patients with AF after RFA were identified through electronic searches of PubMed, Embase, and the Cochrane Library database. Results: Ten studies with 14 735 participants undergoing RFA were included. Procedure duration was significantly longer in patients with overweight or obesity than in patients with normal BMI, with a mean difference (MD) of 0.95. Patients with overweight and obesity were exposed to a larger radiation dose, with standard MD of 1.71 and 1.98, respectively. There was no significant association between overweight or obesity and the risk of procedural complications (RR of 0.91 for overweight, 1.01 for obesity, 0.89 for stage I obesity, 1.00 for stage II obesity, and 0.94 for stage III obesity). Further analysis showed there was no significant difference regarding stroke or transient ischemic attack (

Atrial fibrillation catheter ablation complications in obese and diabetic patients: Insights from the US Nationwide Inpatient Sample 2005–2013

“…Moreover, obese patients undergoing general anesthesia or conscious sedation during this relatively lengthy procedure may experience higher rates of respiratory complications related to worse respiratory mechanics. 35 Obese patients have been shown to have significantly longer procedural duration than non‐obese patients in a meta‐analysis, 18 possibly contributing to respiratory complications. The higher costs associated with obesity may be indicative of differences in anesthesia approaches (more general anesthesia rather than sedation) and not just hospital stay and complications.…”

“…Others have shown that risk factor modification reduces the risk of incident and recurrent AF 16,17 . In terms of procedural complications, meta‐analyses of AF ablation data in obese and diabetic patients primarily from specialized centers have shown comparable rates to non‐obese and non‐diabetic patients 18,19 . However, the real‐world rate of adverse in‐hospital ablation outcomes in obese and diabetic patients remains largely unknown.…”

Atrial Fibrillation Catheter Ablation Complications in Obese and Diabetic Patients: Insights from the US Nationwide Inpatient Sample 2005-2013.

“…Compared to patients with neither comorbidity, those with either obesity, diabetes or both had higher rates of chronic diseases and a higher proportion had their ablation performed at low-volume centers. 18.8% (N = 2315) in 2013 (p < 0.001). There was a dip in the total number of captured ablations after 2011, likely due to the increased labeling of some of these procedures as outpatient.…”

“…Moreover, obese patients undergoing general anesthesia or conscious sedation during this relatively lengthy procedure may experience higher rates of respiratory complications related to worse respiratory mechanics 32 . Obese patients have been shown to have signi cantly longer procedural duration than non-obese patients in a meta-analysis 18 , possibly contributing to respiratory complications. The higher costs associated with obesity may be indicative of differences in anesthesia approaches (more general anesthesia rather than sedation) and not just hospital stay and complications.…”

“…Others have shown that risk factor modi cation reduces the risk of incident and recurrent AF 16,17 . In terms of procedural complications, meta-analyses of AF ablation data in obese and diabetic patients primarily from specialized centers have shown comparable rates to nonobese and non-diabetic patients 18,19 . However, the real-world rate of adverse in-hospital ablation outcomes in obese and diabetic patients remains largely unknown.…”