Okamatsu Hideharu, Okumura Ken, Onishi Fumitaka, Yoshimura Akino, Negishi Kodai, Tsurugi Takuo, Tanaka Yasuaki, Fujita Miki, Nakao Koichi, Sakamoto Tomohiro, Koyama Junjiro, Tomita Hirofumi
Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Heart Rhythm O2. 2024 Oct 10;5(12):890-899. doi: 10.1016/j.hroo.2024.09.020. eCollection 2024 Dec.
We previously reported the relationship between first-pass pulmonary vein isolation (FPI) and pulmonary vein isolation (PVI) durability in ablation index-guided atrial fibrillation ablation. Obesity is a worsening factor for atrial tachyarrhythmia (AT) recurrence. However, the impact of obesity on FPI has been scarcely reported. General anesthesia (GA) facilitates completing PVI by preventing airway obstruction caused by sedative drug use. However, the impact of GA on the relationship also has not been elucidated.
The study sought to evaluate the impact of obesity and its relationship with GA on FPI.
We retrospectively studied 2187 consecutive patients undergoing ablation index-guided first atrial fibrillation ablation (conscious sedation in 1969 and GA in 218). We divided them into 4 groups according to body mass index (BMI): underweight (BMI < 18.5 kg/m2) (n = 80), normal (18.5 kg/m2 ≤ BMI < 25 kg/m2) (n = 1,160), overweight (25 kg/m2 ≤ BMI < 30 kg/m2) (n = 763), and obesity (BMI ≥30 kg/m2) (n = 184).
FPI rate decreased as BMI increased in both conscious sedation (68.1% in underweight, 61.5% in normal, 48.7% in overweight, and 39.0% in obesity; .001) and GA (87.5%, 67.1%, 61.3%, and 44.7%, respectively; .01). Multivariate analysis revealed overweight (odds ratio 0.65, 95% confidence interval [CI] 0.53-0.79, .001, vs normal) and obesity (OR 0.44, 95% CI 0.31-0.62 .001, vs normal) as independent predictors for FPI and obesity as an AT recurrence predictor (hazard ratio 1.35, 95% CI 1.01-1.81, .04).
BMI increase was negatively related to the FPI rate. Notably, the FPI rate in obese patients, even under GA, was low, which might be related to their high AT recurrence.
我们之前报道了在消融指数引导的心房颤动消融中首次通过肺静脉隔离（FPI）与肺静脉隔离（PVI）耐久性之间的关系。肥胖是心房快速性心律失常（AT）复发的一个恶化因素。然而，肥胖对FPI的影响鲜有报道。全身麻醉（GA）通过防止因使用镇静药物引起的气道阻塞，有助于完成PVI。然而，GA对这种关系的影响也尚未阐明。
本研究旨在评估肥胖及其与GA的关系对FPI的影响。
我们回顾性研究了2187例连续接受消融指数引导的首次心房颤动消融的患者（1969例采用清醒镇静，218例采用GA）。我们根据体重指数（BMI）将他们分为4组：体重过轻（BMI<18.5kg/m²）（n = 80）、正常（18.5kg/m²≤BMI<25kg/m²）（n = 1160）、超重（25kg/m²≤BMI<30kg/m²）（n = 763）和肥胖（BMI≥30kg/m²）（n = 184）。
在清醒镇静组（体重过轻组为68.1%，正常组为61.5%，超重组为48.7%，肥胖组为39.0%；P<0.001）和GA组（分别为87.5%、67.1%、61.3%和44.7%；P = 0.01）中，FPI率均随BMI增加而降低。多因素分析显示，超重（比值比0.65，95%置信区间[CI]0.53 - 0.79，P<0.001，与正常组相比）和肥胖（OR 0.44，95%CI 0.31 - 0.62，P<0.001，与正常组相比）是FPI的独立预测因素，肥胖是AT复发的预测因素（风险比1.35，95%CI 1.01 - 1.81，P = 0.04）。
BMI增加与FPI率呈负相关。值得注意的是，肥胖患者即使在GA下FPI率也较低，这可能与他们较高的AT复发率有关。
