Relation of Morbid Obesity and Female Gender to Risk of Procedural Complications in Patients Undergoing Atrial Fibrillation Ablation

Abstract

Obese patients with atrial fibrillation (AF) are frequently managed with AF ablation. We sought to examine whether there exists a body mass index (BMI) threshold beyond which odds of experiencing a complication from AF ablation increase. All patients enrolled in the Vanderbilt AF Registry who underwent catheter-based AF ablation from May 1999 to February 2012 were included. Major complications were recorded. Morbid obesity was defined as BMI >40 kg/m2, and BMI as a continuous variable was examined in multivariable analysis. Thirty-five complications (6.8%) occurred in 512 ablations. Morbidly obese patients experienced a higher rate of complications (6/42, 14.3%) than non-morbidly obese (29/470, 6.2%) (P=0.046). Using a discrete BMI cut-off, the odds of complications increased 3.1-fold in those with morbid obesity (odds ratio [OR] 3.1, 95% Confidence Interval [CI] 1.1–8.4, P=0.03) and 2.1-fold by female gender (OR 2.1, 95% CI 1.04–4.38, P=0.04). With BMI as a continuous variable, the odds of complications increased by 5% per 1 unit increase in BMI (OR 1.05, 95% CI 1.0–1.11, P=0.05) and there was a 2.2-fold increase by female gender (OR 2.2, 95% CI 1.1–4.6, P=0.03). In conclusion, morbid obesity represents a BMI threshold above which the odds of complications with AF ablation significantly increase. The increase in complications appears to be driven primarily by events in women suggesting that morbidly obese women are a special population to consider when considering AF ablation.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Otyłość powiązano również z większą dawką promieniowania i częstością występowania powikłań podczas ablacji AF [302,303]. Warto zauważyć, że poprawa objawowa po przezcewnikowej ablacji AF u otyłych pacjentów wydaje się podobna jak u pacjentów o prawidłowej masie ciała [298].…”

Catheter Ablation of Lone Atrial Fibrillation

“…There is consistency of the data from several studies on the increased procedural risk in women [127,[130][131][132]]. An analysis of 517 AF ablation procedures showed that female gender was an independent predictor of major complications (OR 3.…”

“…An analysis of 517 AF ablation procedures showed that female gender was an independent predictor of major complications (OR 3. [132]. For every unit of BMI increment, the probability of complications (mostly vascular) increased by 5% in the entire group, and more than twice (OR 2.23 [95% CI:…”

Impact of body mass index on the outcome of catheter ablation of atrial fibrillation

“…Previous data support a higher periprocedural complication rate for patients with obesity undergoing ablation,7 although these results remain elusive. The Atrial Fibrillation Ablation Registry was conducted by the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC).…”