Department of Cardiology and Cardiac Surgery, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands.
Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600MB Eindhoven, The Netherlands.
Europace. 2024 Jun 3;26(6). doi: 10.1093/europace/euae157.
Increasing numbers of overweight and obese patients undergo pulmonary vein isolation (PVI), despite the association between higher body mass index (BMI) and adverse PVI outcomes. Evidence on complications and quality of life in different bodyweight groups is limited. This study aims to clarify the impact of BMI on repeat ablations, periprocedural complications, and changes in quality of life.
This multi-centre study analysed prospectively collected data from 15 ablation centres, covering all first-time PVI patients in the Netherlands from 2015 to 2021. Patients were categorized by BMI: normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obesity (≥30 kg/m2). Quality of life was assessed using the Atrial Fibrillation Effect on QualiTy-of-life questionnaire at baseline and 1-year post-PVI. Among 20 725 patients, 30% were of normal weight, 47% overweight, and 23% obese. Within the first year after PVI, obese patients had a higher incidence of repeat ablations than normal-weighing and overweight patients (17.8 vs. 15.6 and 16.1%, P < 0.05). Obesity was independently associated with repeat ablations (odds ratio 1.15; 95% confidence interval 1.01-1.31, P = 0.03). This association remained apparent after 3 years. Complication rates were 3.8% in normal weight, 3.0% in overweight, and 4.6% in obese, with weight class not being an independent predictor. Quality of life improved in all weight groups post-PVI but remained lowest in obese patients.
Obesity is independently associated with a higher rate of repeat ablations. Pulmonary vein isolation is equally safe in all weight classes. Despite lower quality of life among obese individuals, substantial improvements occur for all weight groups after PVI.
尽管较高的体重指数（BMI）与不利的 PVI 结果相关，但越来越多的超重和肥胖患者接受了肺静脉隔离（PVI）。关于不同体重组的并发症和生活质量的证据有限。本研究旨在阐明 BMI 对重复消融、围手术期并发症和生活质量变化的影响。
这项多中心研究前瞻性地分析了 2015 年至 2021 年荷兰 15 个消融中心所有首次 PVI 患者的临床数据。患者按 BMI 分类：正常体重（18.5-24.9kg/m2）、超重（25-29.9kg/m2）和肥胖（≥30kg/m2）。在 PVI 前和 1 年后使用房颤对生活质量的影响问卷评估生活质量。在 20725 名患者中，30%为正常体重，47%为超重，23%为肥胖。在 PVI 后的第一年，肥胖患者比正常体重和超重患者有更高的重复消融发生率（17.8%比 15.6%和 16.1%，P < 0.05）。肥胖是重复消融的独立相关因素（比值比 1.15；95%置信区间 1.01-1.31，P = 0.03）。这一关联在 3 年后仍然存在。正常体重患者的并发症发生率为 3.8%，超重患者为 3.0%，肥胖患者为 4.6%，体重类别不是独立的预测因素。所有体重组在 PVI 后生活质量均有改善，但肥胖患者的生活质量仍最低。
肥胖与重复消融率较高独立相关。在所有体重组中，PVI 同样安全。尽管肥胖患者的生活质量较低，但所有体重组在 PVI 后都有显著改善。
