Johns Hopkins Hospital Heart and Vascular Institute, Baltimore, MD, USA.
Division of Cardiology, Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
J Cardiovasc Electrophysiol. 2018 Feb;29(2):239-245. doi: 10.1111/jce.13388. Epub 2017 Dec 14.
Catheter ablation is common for patients with symptomatic, drug-refractory atrial fibrillation (AF). Obesity is a known risk factor for incident AF. The impact of obesity on AF ablation outcomes is incompletely understood. We sought to determine the impact of elevated body mass index (BMI) on pulmonary vein isolation (PVI) procedural outcomes and associated complications.
We evaluated patients undergoing PVI from 2001 to 2015, dividing them into four groups: normal weight (BMI ≥ 18.5 to < 25), overweight (BMI ≥ 25 to < 30), obese (BMI > 30 to < 40), and morbidly obese (BMI ≥ 40). Demographic and procedural characteristics, complications, and ablation outcomes were compared among groups. A total of 701 patients (146 time-matched controls, 227 overweight, 244 obese, and 84 morbidly obese) with complete demographic, procedural, and follow-up data were included. Increasing BMI correlated positively with HTN, OSA, CHA DS -VASC score, and persistent AF (P ≤ 0.001 for all associations). Radiofrequency application time and intraprocedural heparin dose increased with BMI (P ≤ 0.001). Arrhythmia recurrence at 1 year was 39.9% in controls, while higher in all high-BMI groups (overweight, 51.3%; obese, 57%; morbidly obese, 58.1 %; P = 0.007 for all versus controls). Impact of BMI on AF recurrence was not seen in persistent AF patients. Complication rates across groups were similar.
AF recurrence after catheter ablation is higher in overweight, obese, and morbidly obese patients comparing to normal-weight controls, driven primarily by outcomes differences in paroxysmal AF patients. Complications were not associated with increased BMI.
导管消融是治疗有症状、药物难治性心房颤动（AF）患者的常用方法。肥胖是 AF 发生的已知危险因素。肥胖对 AF 消融结果的影响尚不完全清楚。我们旨在确定升高的体重指数（BMI）对肺静脉隔离（PVI）程序结果和相关并发症的影响。
我们评估了 2001 年至 2015 年期间接受 PVI 的患者，将他们分为四组：正常体重（BMI≥18.5 至<25）、超重（BMI≥25 至<30）、肥胖（BMI>30 至<40）和病态肥胖（BMI≥40）。比较了各组之间的人口统计学和程序特征、并发症和消融结果。共纳入 701 例患者（146 例匹配的对照组、227 例超重、244 例肥胖和 84 例病态肥胖），这些患者具有完整的人口统计学、程序和随访数据。BMI 与 HTN、OSA、CHA DS-VASC 评分和持续性 AF 呈正相关（所有关联 P≤0.001）。随着 BMI 的增加，射频应用时间和术中肝素剂量增加（P≤0.001）。对照组 1 年时心律失常复发率为 39.9%，而所有高 BMI 组的复发率更高（超重组为 51.3%、肥胖组为 57%、病态肥胖组为 58.1%；与对照组相比，所有组均 P=0.007）。在持续性 AF 患者中，BMI 对 AF 复发无影响。各组之间的并发症发生率相似。
与正常体重对照组相比，超重、肥胖和病态肥胖患者在接受导管消融后，AF 复发率更高，主要归因于阵发性 AF 患者的结局差异。并发症与 BMI 升高无关。
