Cryoablation for pulmonary veins isolation in obese patients with atrial fibrillation compared to nonobese patients.


Journal

Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944

Informations de publication

Date de publication:
02 2021
Historique:
received: 28 07 2020
revised: 09 11 2020
accepted: 06 12 2020
pubmed: 30 12 2020
medline: 24 12 2021
entrez: 29 12 2020
Statut: ppublish

Résumé

Pulmonary veins isolation (PVI) by cryoballoon (CB) ablation is marginally represented in clinical studies in obese patients. The aim of this analysis was to evaluate the safety and efficacy of CB-PVI in a large cohort of overweight and obese patients from the 1STOP project. From 2012 to 2018, 2048 patients with atrial fibrillation (AF) (70% male, 59 ± 11 years; 75% paroxysmal AF) underwent index CB-PVI. The patient data were separated into three cohorts for statistical evaluation, including: normal weight (body mass index [BMI] < 25 kg/m Out of 2048 patients, 693 (34%) patients had a BMI < 25 and were deemed as normal. There were 944 (46%) patients categorized as overweight (BMI = 25-30) and 411 (20%) as obese (BMI > 30). Overweight or obese patients were more often in persistent AF, had more frequently hypertension and diabetes, had higher CHA CB-PVI in obese patients is a safe procedure. Increased BMI (either moderate or severe) does not seem to be associated with a worse outcome or to a different rate of AAD discontinuation at 12 months.

Sections du résumé

BACKGROUND
Pulmonary veins isolation (PVI) by cryoballoon (CB) ablation is marginally represented in clinical studies in obese patients. The aim of this analysis was to evaluate the safety and efficacy of CB-PVI in a large cohort of overweight and obese patients from the 1STOP project.
METHODS
From 2012 to 2018, 2048 patients with atrial fibrillation (AF) (70% male, 59 ± 11 years; 75% paroxysmal AF) underwent index CB-PVI. The patient data were separated into three cohorts for statistical evaluation, including: normal weight (body mass index [BMI] < 25 kg/m
RESULTS
Out of 2048 patients, 693 (34%) patients had a BMI < 25 and were deemed as normal. There were 944 (46%) patients categorized as overweight (BMI = 25-30) and 411 (20%) as obese (BMI > 30). Overweight or obese patients were more often in persistent AF, had more frequently hypertension and diabetes, had higher CHA
CONCLUSION
CB-PVI in obese patients is a safe procedure. Increased BMI (either moderate or severe) does not seem to be associated with a worse outcome or to a different rate of AAD discontinuation at 12 months.

Identifiants

pubmed: 33372267
doi: 10.1111/pace.14149
doi:

Types de publication

Comparative Study Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

306-317

Informations de copyright

© 2020 Wiley Periodicals LLC.

Références

Haim M, Hoshen M, Reges O, Rabi Y,Balicer R, Leibowitz M. Prospective national study of the prevalence, incidence, management and outcome of a large contemporary cohort of patients with incident non-valvular atrial fibrillation. J Am Heart Assoc. 2015;4:e1486.
Stewart S, Hart CL, Hole DJ, McMurray JJ. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med. 2002;113:359-364.
Huxley RR, Lopez FL, Folsom AR, et al. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2011;123:1501-1508.
Wilson PWF, D'Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med. 2002;162:1867-1872.
Lloyd-Jones DM, Wang TJ, Leip EP, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004;110:1042-1046.
Gami AS, Hodge DO, Herges RM, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49:565-571.
Tedrow UB, Conen D, Ridker PM, et al. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (Women's Health Study). J Am Coll Cardiol. 2010;55:2319-2327.
Wang TJ, Parise H, Levy D, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA. 2004;292:2471-2477.
Kosiuk J, Van Belle Y, Bode K, et al. Left ventricular diastolic dysfunction in atrial fibrillation: predictors and relation with symptom severity. J Cardiovasc Electrophysiol. 2012;23:1073-1077.
Thanassoulis G, Massaro JM, O'Donnell CJ, et al. Pericardial fat is associated with prevalent atrial fibrillation: the Framingham Heart Study. Circ Arrhythm Electrophysiol. 2010;3:345-350.
Teh AW, Kistler PM, Lee G, et al. Electroanatomic remodeling of the left atrium in paroxysmal and persistent atrial fibrillation patients without structural heart disease. J Cardiovasc Electrophysiol. 2012;23:232-238.
Dublin S, French B, Glazer NL, et al. Risk of new-onset atrial fibrillation in relation to body mass index. Arch Intern Med. 2006;166:2322-2328.
Charitakis E, Barmano N, Walfridsson U, Walfridsson H. Factors predicting arrhythmia-related symptoms and health-related quality of life in patients referred for radiofrequency ablation of atrial fibrillation: an observational study (the SMURF Study). JACC Clin Electrophysiol. 2017;3:494-502.
Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA. 2013;310:2050-2060.
Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol. 2017;50:1-55.
Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18:1609-1678.
Wong CX, Sullivan T, Sun MT, et al. Obesity and the risk of incident, post-operative, and postablation atrial fibrillation: a meta-analysis of 626,603 individuals in 51 studies. JACC: Clinical Electrophysiol. 2015;1:139-152.
Pathak RK, Middeldorp ME, Lau DH, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol. 2014;64:2222-2231.
World Health Organization. Obesity and overweight: fact sheet. http://www.who.int/mediacentre/factsheets/fs311/en/.
Glover BM, Hong KL, Dagres N, et al. Impact of body mass index on the outcome of catheter ablation of atrial fibrillation. Heart. 2019;105:244-250. https://doi.org/10.1136/heartjnl-2018-313490.
De Maat GE, Mulder BA, Berretty WL, et al. Obesity is associated with impaired long term success of pulmonary vein isolation: a plea for risk factor management before ablation. Open Heart. 2018;5:e000771. https://doi.org/10.1136/openhrt-2017-000771.
Winkle RA, Mead RH, Engel G, et al. Impact of obesity on atrial fibrillation ablation: patient characteristics, long-term outcomes, and complications. Heart Rhythm. 2017;14:819-827.
Vyas V, Lambiase P. Obesity and atrial fibrillation: epidemiology, pathophysiology and novel therapeutic opportunities. Arrhythm Electrophysiol Rev. 2019;8:28-36. https://doi.org/10.15420/aer.2018.76.2.
Kuck KH, Fürnkranz A, Chun KR, et al.; FIRE AND ICE Investigators. Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial. Eur Heart J. 2016;37:2858-2865.
deSimone G, Daniels SR, Devereux RB, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Card. 1992;20:1251-1260.
Faroux L, Lesaffre F, Blanpain T, Mora C, Nazeyrollas P, Metz D. Impact of obesity on overall radiation exposure for patients who underwent radiofrequency ablation of atrial fibrillation. Am J Cardiol. 2019;124:1213-1217. https://doi.org/10.1016/j.amjcard.2019.07.018.
Wylie JV Jr, Josephson ME. Catheter ablation for atrial fibrillation in patients with obesity. J Atr Fibrillation. 2008;1:100. https://doi.org/10.4022/jafib.100.
Mugnai G, de Asmundis C, Velagic V, et al. Phrenic nerve injury during ablation with the second-generation cryoballoon: analysis of the temperature drop behaviour in a large cohort of patients. Europace. 2016;18:702-709. https://doi.org/10.1093/europace/euv346.
Mahajan R, Nelson A, Pathak RK, et al. Electroanatomical remodeling of the atria in obesity: impact of adjacent epicardial fat. JACC Clin Electrophysiol. 2018;4:1529-1540. https://doi.org/10.1016/j.jacep.2018.08.014.
Kang JH, Lee DI, Kim S, et al. Prediction of long-term outcomes of catheter ablation of persistent atrial fibrillation by parameters of preablation DC cardioversion. J Cardiovasc Electrophysiol. 2012;23:1165-1170.
Patel D, Mohanty P, Di Biase L, et al. Outcomes and complications of catheter ablation for atrial fibrillation in females. Heart Rhythm. 2010;7:167-172.
Providência R, Adragão P, de Asmundis C, et al. Impact of body mass index on the outcomes of catheter ablation of atrial fibrillation: a European observational multicenter study. J Am Heart Assoc. 2019;8:e012253. https://doi.org/10.1161/JAHA.119.012253.

Auteurs

Daniele Malaspina (D)

Department of Cardiology, ASST Santi Paolo e Carlo, Presidio Ospedaliero San Carlo Borromeo, Milano, Italy.

Francesco Brasca (F)

Department of Cardiology, Ospedale San Luca, Istituto Auxologico, Milano, Italy.

Saverio Iacopino (S)

Arrhythmology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.

Giuseppe Arena (G)

Ospedale delle Apuane, Cardiology Department, Massa, Italy.

Giulio Molon (G)

Department of Cardiology, IRCCS Sacro Cuore don Calabria, Negrar, Italy.

Paolo Pieragnoli (P)

Ospedale Careggi, University of Florence, Florence.

Claudio Tondo (C)

Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS. Milan.

Massimiliano Manfrin (M)

Department of Cardiology, Ospedale Centrale di Bolzano, Bolzano.

Giovanni Rovaris (G)

Department of Cardiology, ASST San Gerardo di Monza.

Roberto Verlato (R)

AULSS 6 Euganea, Ospedale di Cittadella-Camposampiero, Padova, Italy.

Antonio Dello Russo (A)

Biomedical Science and Public Health Department, Cardiology and Arrhythmology Clinic, Polytechnic University, Ancona, Italy.

Umberto Startari (U)

Fondazione Gabriele Monasterio, Pisa.

Giuseppe Sgarito (G)

Civico Fatebenefratelli, Palermo, Italy.

Giovanni Battista Perego (GB)

Department of Cardiology, Ospedale San Luca, Istituto Auxologico, Milano, Italy.

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