Meulendijks Eva R, Roelofs Manouck J M, de Vries Tim A C, Wesselink Robin, Al-Shama Rushd F M, van Boven Wim-Jan P, Driessen Antoine H G, Berger Wouter R, de Jong Jonas S S G, de Groot Joris R
Department of Clinical and Experimental Cardiology, and Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, Netherlands.
Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands.
Front Cardiovasc Med. 2025 Mar 4;12:1433790. doi: 10.3389/fcvm.2025.1433790. eCollection 2025.
Obesity is an important risk factor for atrial fibrillation (AF) development and progression. Furthermore, obesity reduces health-related quality of life (HRQoL), an essential indicator for treatment efficacy of AF ablation. Nevertheless, the extent to which obesity influences changes in HRQoL and the recurrence of AF following ablation, especially thoracoscopic AF ablation, remains largely unexplored.
We assessed in obese vs. non-obese patients undergoing thoracoscopic AF ablation: (1) HRQoL upon ablation, (2) AF recurrence incidence, (3) the association between recurrence incidence and HRQoL.
METHODS & RESULTS: 408 prospectively enrolled patients were included for analysis. Heart rhythm was systematically monitored during follow-up. AF recurrence was defined as any atrial tachyarrhythmia episode > 30 s. HRQoL and recurrence incidence were assessed for normal weight (BMI ≤ 24.9 kg/m), overweight (25.0-29.9 kg/m) and obese (≥30.0 kg/m) patients. HRQoL was assessed at baseline and 1-year follow-up. Obese patients scored lower in pre-operative HRQoL across 6/8 subscales vs. non-obese patients ( < 0.01-0.05). While HRQoL increased in all patients, obese patients showed a trend towards an even greater improvement of mental HRQoL ( = 0.07) vs. non- obese patients. In obesity, mental HRQoL increased similarly for those with and without AF recurrence ( = 0.78), whereas in non-obese patients, AF recurrence was associated with less improved mental HRQoL ( = 0.03). AF recurrence at 1-year was similar between all weight groups (72.4%, 68.0%, 70.4%, = 0.69).
After thoracoscopic ablation, obese patients experience a comparable incidence of AF recurrence as non-obese patients. Interestingly, obese patients also exhibit a more significant enhancement in mental quality of life, regardless of whether AF recurs or not.
肥胖是心房颤动（AF）发生和进展的重要危险因素。此外，肥胖会降低健康相关生活质量（HRQoL），这是房颤消融治疗效果的一项重要指标。然而，肥胖对HRQoL变化以及消融术后房颤复发的影响程度，尤其是胸腔镜下房颤消融，在很大程度上仍未得到充分研究。
我们在接受胸腔镜下房颤消融的肥胖与非肥胖患者中评估：（1）消融时的HRQoL；（2）房颤复发率；（3）复发率与HRQoL之间的关联。
纳入408例前瞻性登记的患者进行分析。随访期间系统监测心律。房颤复发定义为任何持续时间超过30秒的房性快速性心律失常发作。对体重正常（BMI≤24.9kg/m²）、超重（25.0 - 29.9kg/m²）和肥胖（≥30.0kg/m²）的患者评估HRQoL和复发率。在基线和1年随访时评估HRQoL。与非肥胖患者相比，肥胖患者在术前HRQoL的8个分量表中的6个分量表得分更低（P < 0.01 - 0.05）。虽然所有患者的HRQoL均有所提高，但与非肥胖患者相比，肥胖患者在心理HRQoL方面有更大改善的趋势（P = 0.07）。在肥胖患者中，有房颤复发和无房颤复发者的心理HRQoL改善相似（P = 0.78），而在非肥胖患者中，房颤复发与心理HRQoL改善较少相关（P = 0.03）。所有体重组1年时的房颤复发率相似（72.4%、68.0%、70.4%，P = 0.69）。
胸腔镜消融术后，肥胖患者的房颤复发率与非肥胖患者相当。有趣的是，无论房颤是否复发，肥胖患者的心理生活质量也有更显著的提高。
