Bidaoui Ghassan, Tsakiris Eli, Younes Hadi, Feng Han, Assaf Ala, Chouman Nour, Bsoul Mayana, Polo Francisco Tirado, Jia Yishi, Liu Yingshou, Lim Chanho, Chamoun Nadia, Mekhael Mario, Noujaim Charbel, Pandey Amitabh C, Rao Swati, Kreidieh Omar, Marrouche Nassir F, Donnellan Eoin
Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
J Cardiovasc Electrophysiol. 2024 Dec;35(12):2330-2341. doi: 10.1111/jce.16448. Epub 2024 Sep 30.
Obesity is implicated in adverse atrial remodeling and worse outcomes in patients with atrial fibrillation. The objective of this study is to assess the effect of body mass index (BMI) on ablation-induced scar formation on late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR).
We conducted an analysis of DECAAF II participants who underwent LGE-CMR scans to measure scar formation 3 months after catheter ablation. Ablation parameters and lesion delivery were not dependent on BMI. The effect of BMI on ablation success was explored.
Our analyses included 811 patients. Comorbidities were more prevalent in obese patients. Baseline left atrial volume was higher in obese individuals, 118, 126, 135, 140, and 143 mm for normal weight, overweight, obese grade 1, 2, and 3, respectively (p < .001). BMI was associated with scar formation (R = -0.135, p < .001), with patients with Class 3 obesity having the lowest percentage of ablation-induced scar, 11.1%, 10.3%, 9.5%, 8.8%, 6.8% by ascending BMI group. There was an inverse correlation between BMI and the amount of fibrosis covered by ablation scar, 24%, 23%, 21%, and 18% by ascending BMI group (p = .001). For the fibrosis-guided ablation group, BMI was associated with residual fibrosis (R = 0.056, p = .005).
Obese patients have lower ablation scar formation, covered fibrosis, and more residual fibrosis postablation compared to nonobese patients, regardless of ablation parameters including impedance drop.
肥胖与心房颤动患者的不良心房重构及更差的预后相关。本研究的目的是评估体重指数（BMI）对钆增强延迟心脏磁共振成像（LGE-CMR）上消融诱导瘢痕形成的影响。
我们对接受LGE-CMR扫描以测量导管消融术后3个月瘢痕形成情况的DECAAF II参与者进行了分析。消融参数和病灶传递不依赖于BMI。探讨了BMI对消融成功的影响。
我们的分析纳入了811例患者。肥胖患者的合并症更为普遍。肥胖个体的基线左心房容积更高，正常体重、超重、1级肥胖、2级肥胖和3级肥胖患者的左心房容积分别为118、126、135、140和143mm（p <.001）。BMI与瘢痕形成相关（R = -0.135，p <.001），3级肥胖患者的消融诱导瘢痕百分比最低，按BMI升序分组分别为11.1%、10.3%、9.5%、8.8%、6.8%。BMI与消融瘢痕覆盖的纤维化量呈负相关，按BMI升序分组分别为24%、23%、21%和18%（p =.001）。对于纤维化引导消融组，BMI与残余纤维化相关（R = 0.056，p =.005）。
与非肥胖患者相比，肥胖患者的消融瘢痕形成更低，覆盖的纤维化更少，且消融后残余纤维化更多，无论包括阻抗下降在内的消融参数如何。
