RT Journal Article
SR Electronic
T1 Obesity is associated with impaired long-term success of pulmonary vein isolation: a plea for risk factor management before ablation
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e000771
DO 10.1136/openhrt-2017-000771
VO 5
IS 1
A1 Gijs E De Maat
A1 Bart Mulder
A1 Wouter L Berretty
A1 Meelad I H Al-Jazairi
A1 Yong E S Tan
A1 Ans C P Wiesfeld
A1 Massimo A Mariani
A1 Isabelle C Van Gelder
A1 Michiel Rienstra
A1 Yuri Blaauw
YR 2018
UL http://openheart.bmj.com/content/5/1/e000771.abstract
AB Aims Obesity is an increasing health problem and is an important risk factor for the development of atrial fibrillation (AF). We investigated the association of body mass index (BMI) on the safety and long-term efficacy of pulmonary vein isolation (PVI) for drug-refractory AF.Methods 414 consecutive patients who underwent transcatheter PVI for AF between 2003 and 2013 were included. Successful PVI was defined as absence of atrial arrhythmia on Holter monitoring or ECG, without and with antiarrhythmic drugs during follow-up. Obesity was defined as BMI≥30 kg/m².Results Mean age was 56±10 years, 316 (76%) were male, 311 (75%) had paroxysmal AF and 111 (27%) were obese. After a mean follow-up of 46±32 months (1590 patient-years), freedom from atrial arrhythmia and antiarrhythmic drugs was significantly lower in patients with obesity compared with non-obese patients (30% vs 46%, respectively, P=0.005, log-rank 0.016). With antiarrhythmic drugs, freedom from atrial arrhythmia was 56% vs 68% (P=0.036). No differences in minor and major adverse events were observed between patients with obesity and non-obese patients (major 6% vs 3%, P=0.105, and minor 5% vs 5%, P=0.512). Sensitivity analyses demonstrated that BMI (as continuous variable) was associated with PVI outcome (HR 1.08, 95% CI 1.02 to 1.14, P=0.012).Conclusion Obesity is associated with reduced efficacy of PVI for drug-refractory AF. No relation between obesity and adverse events was found.