Lakkireddy Dhanunjaya R, Blake George E, Patel Dimpi, Rotter Martin, Verma Atul, Ryschon Kay, Khan Mohammed, Schweikert Robert, Haissaguerre Michel, Natale Andrea
Mid America Cardiology @ University of Kansas Hospital, Kansas City, KS.
Cleveland Clinic Founda tion, Cleveland, OH.
J Atr Fibrillation. 2008 May 16;1(1):36. doi: 10.4022/jafib.36. eCollection 2008 May-Jun.
Catheter ablation of atrial fibrillation (AF) is an increasingly popular therapeutic option for symptomatic patients who have failed multiple antiarrhythmic drugs (AADs). Patients of higher body mass index often fail direct current cardioversion. The role of body mass index (BMI) on the success of AF ablation is not well understood. We prospectively studied 511 patients who underwent AF ablation at the Cleveland Clinic Foundation between 2002 and 2005. Patients were divided into four classes based on their BMI: Class I ( 25); Class II (25.1-30); Class III (30.1-35) and Class IV (>35). These groups were compared for baseline demographic and clinical characteristics. Any recurrence of AF after 3 months of ablation was considered as failure. All classes were followed for at least 12 months and rates of failure were compared. Based on their BMI, 25% of patients were assigned to class I, 37% in class II, 21% in class III and 16% in class IV. Patients of higher classification (class III or IV) were more likely to be male (p<0.001), diabetic (p<0.001), smokers (p=0.002), with coronary artery disease (=0.018), left atrial enlargement (p=0.015) and longstanding AF (p=0.007). Severity of obesity as measured by BMI had a direct correlation to early (p=0.05) and late (p=0.01) recurrence of AF. Obesity is significantly associated with long-term AF recurrence after catheter ablation. Higher incidence of smoking & left atrial enlargement may possibly contribute to higher failure rates in this sub-group of patients.
对于多种抗心律失常药物（AADs）治疗失败的有症状房颤（AF）患者，导管消融术是一种越来越受欢迎的治疗选择。体重指数较高的患者常无法通过直流电复律成功转复。体重指数（BMI）对房颤消融成功率的作用尚未完全明确。我们对2002年至2005年间在克利夫兰诊所基金会接受房颤消融术的511例患者进行了前瞻性研究。根据BMI将患者分为四类：I类（<25）；II类（25.1 - 30）；III类（30.1 - 35）和IV类（>35）。比较这些组的基线人口统计学和临床特征。消融术后3个月内房颤的任何复发都被视为失败。对所有类别患者至少随访12个月，并比较失败率。根据BMI，25%的患者被归为I类，37%为II类，21%为III类，16%为IV类。分类较高（III类或IV类）的患者更可能为男性（p<0.001）、糖尿病患者（p<0.001）、吸烟者（p = 0.002），患有冠状动脉疾病（p = 0.018）、左心房扩大（p = 0.015）和长期房颤（p = 0.007）。通过BMI衡量的肥胖严重程度与房颤的早期（p = 0.05）和晚期（p = 0.01）复发直接相关。肥胖与导管消融术后房颤的长期复发显著相关。吸烟和左心房扩大的较高发生率可能是导致该亚组患者较高失败率的原因。
