Impact of BMI on outcomes of atrial fibrillation ablation

  • Providência R & al.
  • J Am Heart Assoc
  • 15 Oct 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Obese patients present with a more adverse comorbidity profile, more advanced forms of atrial fibrillation (Afib), and have lower chances of being free from Afib relapse after ablation.
  • The use of novel oral anticoagulants (NOACs) and cryoballoon ablation is safe and have comparable efficacy to vitamin-K antagonists (VKA) and radiofrequency ablation in patients with obesity.

Why this matters

  • Combination of cryoballoon ablation and NOACs may be an alternative treatment option in patients with obesity.

Study design

  • Study of 2497 patients (aged >18 years) undergoing catheter ablation of Afib in 7 European high volume centres during 2014-2015.
  • Patients were stratified according to body mass index (BMI) as:
    • normal weight (2; n=711),
    • pre-obese (25-30 kg/m2; n=1092),
    • obesity (30-35 kg/m2; n=508) and
    • morbid obesity (≥35 kg/m2; n=186).
  • Funding: None disclosed.

Key results

  • Prevalence of non-paroxysmal forms of Afib increased alongside with BMI (P<.001 and the prevalence of risk factors for coronary cerebrovascular disease was higher in patients with bmi>
  • At 12 months, the rate of relapse increased progressively across the 4 BMI classes (all, P<.001 and in normal weight pre-obese obese morbidly patients respectively.>
  • During a median follow-up of 18.8 months, BMI was an independent predictor of relapse (HR, 1.01 [95% CI, 1.00-1.02] per kg/m2; P=.017).
  • NOACs and cryoballoon ablation were comparable to VKA and radiofrequency ablation in obese patients.
    • Radiofrequency vs cryoballoon ablation:
      • all complications (4.6% vs 7.9%),
      • cardiac tamponade (1.0% vs 0.5%),
      • stroke (0.2% vs 0.5%) and
      • vascular complications (1.6% vs 2.6%).
    • NOACs vs VKA:
      • cardiac tamponade (0.6% vs 1.0%),
      • stroke (0% vs 0.4%) and
      • vascular complications (1.7% vs 2.0%).

Limitations

  • Study may not represent the type of ablation activity performed in other centres with lower caseloads.