Department of Cardiology, Sunshine Coast University Hospital, Qld, Australia; School of Medicine, Griffith University, Qld, Australia.
Department of Cardiology, Sunshine Coast University Hospital, Qld, Australia.
Heart Lung Circ. 2024 Jun;33(6):882-889. doi: 10.1016/j.hlc.2024.02.009. Epub 2024 Apr 2.
Modifiable lifestyle risk factors, in particular obesity and related conditions, are important drivers of atrial fibrillation (AF), impacting the severity of symptoms and influence the efficacy and safety of treatment.
The study aimed to assess the impact of modifiable lifestyle factors on the effectiveness and safety of AF ablation, and examine the procedural characteristics, efficacy, safety and cost outcomes of cryoballoon vs radiofrequency ablation, in a real-world clinical setting.
Patients undergoing catheter ablation for AF (June 2017 to December 2020) were included in this retrospective analysis. Efficacy and safety outcomes were obtained from electronic medical records and state-wide databases. The primary outcome was successful isolation of the pulmonary veins and freedom from AF without repeat ablation or ongoing antiarrhythmic therapy at 12 months.
The study included 141 patients (mean age 60±11 years, 57% male). The average body mass index (BMI) was 29.2±5.6 kg/m. Ablation by cryoballoon was undertaken in 59% (radiofrequency 41%). Acutely successful pulmonary vein isolation was achieved in 92%, however, only 52% (n=74) met the primary outcome (successful isolation of the pulmonary veins and freedom from AF without repeat ablation or ongoing antiarrhythmic therapy) at 12 months. Successful management of AF was more likely in patients with lower BMI (p=0.006; particularly with BMI <27 kg/m; p=0.004) and weight (p=0.003), and in those without obstructive sleep apnoea (p=0.032). The only independent predictor of the primary outcome was BMI (β=0.25, p=0.004). Over 75% of complications occurred in those with BMI ≥27 kg/m.
Catheter ablation for AF is more likely to be unsuccessful in patients with uncontrolled risk factors, particularly obesity. Risk factor optimisation may improve procedural success and reduce the risk of procedural complications.
可改变的生活方式风险因素，特别是肥胖和相关疾病，是心房颤动（AF）的重要驱动因素，影响症状的严重程度，并影响治疗的效果和安全性。
本研究旨在评估可改变的生活方式因素对 AF 消融效果和安全性的影响，并在真实临床环境中检查冷冻球囊与射频消融在程序特征、疗效、安全性和成本结果方面的差异。
回顾性分析 2017 年 6 月至 2020 年 12 月期间接受导管消融治疗的 AF 患者。疗效和安全性结果来自电子病历和全州数据库。主要结局是在 12 个月时成功隔离肺静脉，且无需重复消融或持续抗心律失常治疗。
研究纳入了 141 例患者（平均年龄 60±11 岁，57%为男性）。平均体重指数（BMI）为 29.2±5.6kg/m。冷冻球囊消融占 59%（射频消融占 41%）。急性成功实现肺静脉隔离率为 92%，然而，只有 52%（n=74）在 12 个月时达到主要结局（成功隔离肺静脉且无需重复消融或持续抗心律失常治疗）。BMI 较低的患者（p=0.006；特别是 BMI＜27kg/m 时，p=0.004）和体重较轻的患者（p=0.003）以及无阻塞性睡眠呼吸暂停的患者（p=0.032），AF 的管理更有可能成功。主要结局的唯一独立预测因素是 BMI（β=0.25，p=0.004）。超过 75%的并发症发生在 BMI≥27kg/m 的患者中。
对于存在未控制危险因素的患者，特别是肥胖患者，AF 导管消融更有可能不成功。危险因素优化可能会提高程序成功率并降低程序并发症的风险。
