Cryoablation for pulmonary veins isolation in obese patients with atrial fibrillation compared to nonobese patients

Malaspina, D.; Brasca, F.; Iacopino, Saverio; Arena, Giuseppe; Molon, Giulio; Pieragnoli, Paolo; Tondo, Claudio; Manfrin, Massimiliano; Rovaris, Giovanni; Verlato, Roberto; Russo, Antonio Dello; Startari, Umberto; Sgarito, Giuseppe; Perego, Giovanni Battista

doi:10.1111/pace.14149

Cited by 9 publications

(13 citation statements)

References 35 publications

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“…Despite the above-mentioned coherence of studies on the subject of obesity and cardiovascular disease, there are contradicting data on complication rates and the short- and long-term effectiveness of pulmonary vein isolation with regard to rhythm maintenance in obese patients. While some authors report reduced chances of success [ 6 , 7 , 8 , 9 ] and/or increased complication rates, other authors report an equivalent effectiveness of PVI without increased complication rates [ 10 , 11 , 12 ]. It is noteworthy that the difference in outcomes is partly based on the comparison of different ablation procedures or patient groups and morbidity burden variation [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Vein Isolation in Obese Compared to Non-Obese Patients: Real-Life Experience from a Large Tertiary Center

Wolfes¹,

Hoppe²,

Ellermann³

et al. 2022

JCDD

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1. Introduction: Pulmonary vein isolation (PVI) is an established procedure used to achieve rhythm control in atrial fibrillation (AF). In obese patients (pts), in whom AF occurs more frequently, a reduced effectiveness of PVI has been observed. Therefore, this study’s aim was to compare the long-term efficacy of PVI between obese and non-obese patients. 2. Methods: We enrolled 111 consecutive pts with a body mass index (BMI) of >30 kg/m2 undergoing PVI from our large registry. Procedural data and outcomes were compared with a matched group of 115 non-obese PVI pts and the long-term outcomes were analyzed. 3. Results: Overall follow-up duration was 314 patient-years in the obese and 378 patient-years in the non-obese group. The follow-up rate was 71% in the obese and 76% in the non-obese group. In both groups, their AF-characteristics did not differ significantly, while known risk factors were significantly more prevalent in the obese group. Procedural characteristics were similar in both groups. During follow-up, the obese pts demonstrated significant weight loss compared to the non-obese pts, while at the same time, the overall recurrence rate during follow-up did not differ significantly between both groups (obese: 39.2% and non-obese: 43.7%). PVI related and long-term complications were comparable between both groups. In the univariate analysis, obesity was not found to be associated with an increased AF recurrence risk. 4. Conclusion: These real-life data demonstrate that obese pts may not show higher AF recurrence rates after PVI compared to pts with normal body weight. Furthermore, PVI was found to be safe and effective in obese patients; thus, a BMI alone may not be a criterion for refusal of PVI.

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Section: Introductionmentioning

confidence: 99%

Pulmonary Vein Isolation in Obese Compared to Non-Obese Patients: Real-Life Experience from a Large Tertiary Center

Wolfes¹,

Hoppe²,

Ellermann³

et al. 2022

JCDD

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“…They did not find a worse outcome during their follow-up among patients with increased BMI. Furthermore, they found persistent AF was an independent predictor of AF recurrence after ablation [29]. Data on suboptimal outcome after PVI in patients with persistent AF with respect to AF recurrence has been reported before [30,31].…”

Section: Discussionmentioning

confidence: 97%

“…Recently, Malaspina et al [29] reported on more than 2000 patients who underwent CB PVI. They did not find a worse outcome during their follow-up among patients with increased BMI.…”

Section: Discussionmentioning

confidence: 99%

Influence of excess weight and obesity on performance and outcome of pulmonary vein isolation with the cryoballoon

Blockhaus¹,

Waibler²,

Gülker³

et al. 2021

Rev. Cardiovasc. Med.

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Pulmonary vein isolation (PVI) has become a cornerstone therapy in the treatment of atrial fibrillation (AF). Patients with overweight or obesity suffer more often from AF, and studies investigating the safety and feasibility of PVI in these patients have shown varying results. In this study we analyzed PVI performed with the 2nd generation cryoballoon (CB) with regard to safety, procedure and fluoroscopy time in patients with normal weight, overweight and obesity. We analyzed 228 consecutive patients treated with CB PVI in our hospital in 2018 and 2019. Fifty nine (25.88%) patients presented with normal weight (body mass index (BMI) of <math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="w1" alttext=" < 25), 115 (50.44%) patients with overweight (BMI between 25 and 29.9) and 54 (23.68%) were obese patients (BMI " display="inline"> > 30). All pulmonary veins (PV) were isolated successfully. Concerning procedural parameters, neither complications, procedural time, nor fluoroscopy time differed significantly. There was a significant increase of dose area product (DAP) in obese patients compared to normal weight and overweight patients (2035.5 ± 1930.1 μ Gym 2 vs. 975.3 ± 814.9 vs. 1325.1 ± 2081.3, p = 0.001) but no significant difference between overweight and normal weight patients (p = 0.611). Our follow-up data of 168 patients (73.68%) observed for 12 months showed no differences in the recurrence of AF in the three BMI groups [80.9% vs. 83.3% (p = 0.733) vs. 86.55% (p = 0.460)]. In conclusion, CB PVI in overweight and obese patients is safe with similar levels of complications and recurrence of AF as patients of normal weight. However, obese patients and operators are exposed to higher radiation doses.

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“…Different studies have investigated the influence of BMI on long‐term ablation outcomes. Malaspina et al 18 analyzed the outcome of cryoballoon PVI in 2048 patients, without reporting an impact of obesity grade on 12 months follow up. In contrast, Glover et al 19 investigated the impact of BMI on 3333 AF patients that were ablated with RF in a multicenter registry: Three groups were defined (BMI < 25, BMI: 25.5–29, and BMI ≥ 30) showing a worse outcome for patients with a BMI ≥ 30 compared to a BMI of 25.5–29.…”

Section: Discussionmentioning

confidence: 99%

“…Different studies have investigated the influence of BMI on long-term ablation outcomes. Malaspina et al18 analyzed the outcome of cryoballoon PVI in 2048 patients, without reporting an impact of obesity grade on impact of BMI on 3333 AF patients that were ablated with RF in a multicenter registry: Three groups were defined (BMI < 25, BMI:25.5-29, and BMI ≥ 30) showing a worse outcome for patients with a BMI ≥ 30 compared to a BMI of 25.5-29. Winkle et al 11 divided 2715 AF patients who underwent RF ablation by BMI (<25, 25 to <30, 30 to <35, 35 to <40, ≥40) showing a negative impact of obesity on ablation outcomes when BMI exceeds 35.…”

mentioning

confidence: 99%

Impact of body mass index on cryoablation of atrial fibrillation: Patient characteristics, procedural data, and long‐term outcomes

Urbanek

Bordignon

Chen

et al. 2022

Cardiovasc electrophysiol

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Introduction Ablation of atrial fibrillation in the context of obesity can be challenging. We sought to evaluate the role of cryoballoon pulmonary vein isolation (CB‐PVI) in obese patients with symptomatic atrial fibrillation (AF). Methods Patients with a BMI ≥ 25 kg/m2 and symptomatic AF who underwent CB‐PVI were retrospectively enrolled. Three groups were defined (G1: BMI of 25–29 kg/m2; G2: BMI of 30–34 kg/m2; G3: BMI ≥ 35 kg/m2). Results 600 patients were included (59% male; 66 ± 11 years old); 337, 149, and 114 were assigned to G1, G2, and G3, respectively. Acute procedural success was recorded in 99.7% of patients. Procedural and fluoroscopy time were comparable but the radiation dose was significantly higher in G3. Procedural complications were 3% in G1, 5.4% in G2, and 8.8% in G3 (p = .01). The overall freedom from AF after 1‐year was 77%. G3 had a significantly worse 1‐year success rate compared to G1 and G2 (G3: 66.5% vs. G1: 78.4%; p = .015 and vs. G2: 82.5%; p = .008) with reduced 1‐year success in paroxysmal AF (G1: 84.0%; G2: 86.3%; and G3: 69.6%) but not in persistent AF (G1: 68.7%; G2: 77.4%; and G3: 62.1%). G3 showed similar success rates irrespective of AF form (PAF: 69.6% vs. persAF 62.1%; p = .501). Conclusion Cryoballoon ablation in obese patients can be effective with an acceptable safety profile, 77% of patients were in stable SR at 1 year. Severe obese patients (BMI ≥ 35) showed reduced procedural safety and 1‐year success rate. In association with life style modification, CB ablation may represent a strategy to enhance rhythm control in the context of obesity.

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Cryoablation for pulmonary veins isolation in obese patients with atrial fibrillation compared to nonobese patients

Cited by 9 publications

References 35 publications

Pulmonary Vein Isolation in Obese Compared to Non-Obese Patients: Real-Life Experience from a Large Tertiary Center

Pulmonary Vein Isolation in Obese Compared to Non-Obese Patients: Real-Life Experience from a Large Tertiary Center

Influence of excess weight and obesity on performance and outcome of pulmonary vein isolation with the cryoballoon

Impact of body mass index on cryoablation of atrial fibrillation: Patient characteristics, procedural data, and long‐term outcomes

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