肥胖与肺静脉隔离术的长期成功率受损相关：呼吁在消融术前进行危险因素管理。
Obesity is associated with impaired long-term success of pulmonary vein isolation: a plea for risk factor management before ablation.
作者信息
De Maat Gijs E, Mulder Bart A, Berretty Wouter L, Al-Jazairi Meelad I H, Tan Eng-Shiong, Wiesfeld Ans C P, Mariani Massimo A, Van Gelder Isabelle C, Rienstra Michiel, Blaauw Yuri
机构信息
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
出版信息
Open Heart. 2018 May 16;5(1):e000771. doi: 10.1136/openhrt-2017-000771. eCollection 2018.
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.
目的
肥胖是一个日益严重的健康问题，是心房颤动（AF）发生的重要危险因素。我们研究了体重指数（BMI）与药物难治性AF肺静脉隔离（PVI）安全性和长期疗效之间的关联。
方法
纳入2003年至2013年间连续414例行经导管PVI治疗AF的患者。成功的PVI定义为动态心电图监测或心电图未出现房性心律失常，随访期间无论有无抗心律失常药物。肥胖定义为BMI≥30kg/m²。
结果
平均年龄为56±10岁，316例（76%）为男性，311例（75%）为阵发性AF，111例（27%）肥胖。平均随访46±32个月（1590患者年）后，肥胖患者无房性心律失常和抗心律失常药物的比例显著低于非肥胖患者（分别为30%和46%，P=0.005，对数秩0.016）。使用抗心律失常药物时，无房性心律失常的比例分别为56%和68%（P=0.036）。肥胖患者和非肥胖患者之间未观察到轻微和严重不良事件的差异（严重事件6%对3%，P=0.105；轻微事件5%对5%，P=0.512）。敏感性分析表明，BMI（作为连续变量）与PVI结果相关（HR 1.08，95%CI 1.02至1.14，P=0.012）。
结论
肥胖与药物难治性AF的PVI疗效降低相关。未发现肥胖与不良事件之间的关系。
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