Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Frankfurt am Main, Germany.
Gutenberg School of Management and Economics, Johannes Gutenberg University Mainz, Mainz, Germany.
J Cardiovasc Electrophysiol. 2022 Jun;33(6):1106-1115. doi: 10.1111/jce.15478. Epub 2022 Apr 10.
Ablation of atrial fibrillation in the context of obesity can be challenging. We sought to evaluate the role of cryoballoon pulmonary vein isolation (CB-PVI) in obese patients with symptomatic atrial fibrillation (AF).
Patients with a BMI ≥ 25 kg/m and symptomatic AF who underwent CB-PVI were retrospectively enrolled. Three groups were defined (G1: BMI of 25-29 kg/m ; G2: BMI of 30-34 kg/m ; G3: BMI ≥ 35 kg/m ).
600 patients were included (59% male; 66 ± 11 years old); 337, 149, and 114 were assigned to G1, G2, and G3, respectively. Acute procedural success was recorded in 99.7% of patients. Procedural and fluoroscopy time were comparable but the radiation dose was significantly higher in G3. Procedural complications were 3% in G1, 5.4% in G2, and 8.8% in G3 (p = .01). The overall freedom from AF after 1-year was 77%. G3 had a significantly worse 1-year success rate compared to G1 and G2 (G3: 66.5% vs. G1: 78.4%; p = .015 and vs. G2: 82.5%; p = .008) with reduced 1-year success in paroxysmal AF (G1: 84.0%; G2: 86.3%; and G3: 69.6%) but not in persistent AF (G1: 68.7%; G2: 77.4%; and G3: 62.1%). G3 showed similar success rates irrespective of AF form (PAF: 69.6% vs. persAF 62.1%; p = .501).
Cryoballoon ablation in obese patients can be effective with an acceptable safety profile, 77% of patients were in stable SR at 1 year. Severe obese patients (BMI ≥ 35) showed reduced procedural safety and 1-year success rate. In association with life style modification, CB ablation may represent a strategy to enhance rhythm control in the context of obesity.
肥胖患者的房颤消融具有一定挑战性。本研究旨在评估冷冻球囊肺静脉隔离（CB-PVI）在有症状房颤（AF）合并肥胖患者中的作用。
回顾性纳入 BMI≥25kg/m 且有症状 AF 并接受 CB-PVI 的患者。将患者分为三组（G1：BMI 为 25-29kg/m；G2：BMI 为 30-34kg/m；G3：BMI≥35kg/m）。
共纳入 600 例患者（59%为男性，年龄 66±11 岁）；337、149 和 114 例患者分别被分到 G1、G2 和 G3。99.7%的患者即刻手术成功。三组患者的手术时间和透视时间相似，但 G3 组的辐射剂量显著更高。G1、G2 和 G3 组的手术并发症发生率分别为 3%、5.4%和 8.8%（p=0.01）。术后 1 年时，总体 AF 无复发率为 77%。与 G1 和 G2 相比，G3 组的 1 年成功率明显较低（G3：66.5%vs.G1：78.4%；p=0.015；vs.G2：82.5%；p=0.008），阵发性 AF 的 1 年成功率降低（G1：84.0%；G2：86.3%；G3：69.6%），但持续性 AF 无差异（G1：68.7%；G2：77.4%；G3：62.1%）。G3 组无论 AF 类型如何，成功率相似（PAF：69.6%vs.persAF：62.1%；p=0.501）。
在肥胖患者中，冷冻球囊消融是有效的，安全性可接受，77%的患者在 1 年时保持稳定的窦性心律。重度肥胖患者（BMI≥35）的手术安全性和 1 年成功率降低。与生活方式改变相结合，CB 消融可能成为肥胖患者节律控制的一种策略。
