Malnutrition and Risk of Procedural Complications in Patients With Atrial Fibrillation Undergoing Catheter Ablation

Abstract

Background: Little is known about the prognostic value of nutritional status among patients undergoing atrial fibrillation (AF) catheter ablation (AFCA). We compared the risk of procedure-related complications and long-term rhythm outcomes of AFCA according to nutritional status.Methods: We included 3,239 patients undergoing de novo AFCA in 2009-2020. Nutritional status was assessed using the controlling nutritional status (CONUT) score. The association between malnutrition and the risk of AFCA complications or long-term rhythm outcomes was evaluated. We validated the effects of malnutrition using an external cohort of 360 patients undergoing AFCA in 2013-2016.Results: In the study population (26.8% women, median age: 58 years), 1,005 (31.0%) had malnutrition (CONUT scores ≥ 2); 991 (30.6%) had mild (CONUT 2–4) and 14 (0.4%) had moderate-to-severe (CONUT ≥ 5) malnutrition. The overall complication rates after AFCA were 3.3% for normal nutrition, 4.2% for mild malnutrition, and 21.4% for moderate-to-severe malnutrition. Moderate-to-severe malnutrition [odds ratio (OR) 6.456, 95% confidence interval (CI) 1.637-25.463, compared with normal nutrition], older age (OR 1.020 per 1-year increase, 95% CI 1.001-1.039), female sex (OR 1.915, 95% CI 1.302-2.817), and higher systolic blood pressure (OR 1.013 per 1-mmHg increase, 95% CI 1.000-1.026) were independent predictors for the occurrence of complications. In the validation cohort, malnutrition (CONUT ≥ 2) was associated with a 2.87-fold higher risk of AFCA complications (95% CI 1.174-7.033). The association between malnutrition and a higher risk of AFCA complications was consistently observed regardless of body mass index and sex. Malnutrition did not affect rhythm outcomes during the median follow-up of 40 months (clinical recurrence: 37.0% in normal nutrition vs. 36.5% in malnutrition).Conclusion: Malnutrition, which is common in patients undergoing AFCA, was associated with a substantially higher risk for complications after AFCA.

Relationship between nutritional status and length of hospital stay among patients with atrial fibrillation – a result of the nutritional status heart study

“…In the Vijan et al study, independent factors affecting LOHS (≥7 days for this study) included ACS, decompensated HF, increased NT-proBNP levels and infections ( 25 ). Researchers studying nutritional status confirm that malnutrition upon hospital admission is quite common and is associated not only with prolonged hospital stay but also with worse prognosis ( 28 – 31 ). Malnutrition also increases the risk of re-hospitalization in patients with AF.…”

Sex-related differences in the impact of nutritional status on length of hospital stay in atrial fibrillation: a retrospective cohort study

“…Kim et al showed that it increases the risk of complications in AF patients undergoing catheter ablation. The overall complication rate was more marked among malnourished women (7.1%) than malnourished men (3.7%) (28). Monitoring patients' nutritional status is essential to the medical care process, as it can deteriorate during a hospital stay (29).…”

Anti-atrial Fibrillation Effects of Pulmonary Vein Isolation With or Without Ablation Gaps: A Computational Modeling Study

“…Depending on the recurrent AF burden or the operators’ discretion, gap fillings for the reconnected PVs or an empirical extra-PV ablation, such as a posterior wall isolation, have been performed ( Lee et al, 2019 ). In patients with a well-maintained PVI during redo-mapping, extra-PV triggers play a significant role in AF recurrence, and the outcomes of a repeat ablation are worse than in patients with PV reconnections ( Kim et al, 2021 ). In this study, we examined the AF maintenance mechanism during the PVI-gap state by using computational models made with the electroanatomical maps of 40 patients, most of whom had persistent AF.…”