Daniele Malaspina1, Francesco Brasca2, Saverio Iacopino3, Giuseppe Arena4, Giulio Molon5, Paolo Pieragnoli6, Claudio Tondo7, Massimiliano Manfrin8, Giovanni Rovaris9, Roberto Verlato10, Antonio Dello Russo11, Umberto Startari12, Giuseppe Sgarito13, Giovanni Battista Perego2. 1. Department of Cardiology, ASST Santi Paolo e Carlo, Presidio Ospedaliero San Carlo Borromeo, Milano, Italy. 2. Department of Cardiology, Ospedale San Luca, Istituto Auxologico, Milano, Italy. 3. Arrhythmology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy. 4. Ospedale delle Apuane, Cardiology Department, Massa, Italy. 5. Department of Cardiology, IRCCS Sacro Cuore don Calabria, Negrar, Italy. 6. Ospedale Careggi, University of Florence, Florence. 7. Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS. Milan. 8. Department of Cardiology, Ospedale Centrale di Bolzano, Bolzano. 9. Department of Cardiology, ASST San Gerardo di Monza. 10. AULSS 6 Euganea, Ospedale di Cittadella-Camposampiero, Padova, Italy. 11. Biomedical Science and Public Health Department, Cardiology and Arrhythmology Clinic, Polytechnic University, Ancona, Italy. 12. Fondazione Gabriele Monasterio, Pisa. 13. Civico Fatebenefratelli, Palermo, Italy.
Abstract
BACKGROUND: Pulmonary veins isolation (PVI) by cryoballoon (CB) ablation is marginally represented in clinical studies in obese patients. The aim of this analysis was to evaluate the safety and efficacy of CB-PVI in a large cohort of overweight and obese patients from the 1STOP project. METHODS: From 2012 to 2018, 2048 patients with atrial fibrillation (AF) (70% male, 59 ± 11 years; 75% paroxysmal AF) underwent index CB-PVI. The patient data were separated into three cohorts for statistical evaluation, including: normal weight (body mass index [BMI] < 25 kg/m2 ), overweight (BMI = 25-30 kg/m2 ), and obese patients (BMI > 30 kg/m2 ). RESULTS: Out of 2048 patients, 693 (34%) patients had a BMI < 25 and were deemed as normal. There were 944 (46%) patients categorized as overweight (BMI = 25-30) and 411 (20%) as obese (BMI > 30). Overweight or obese patients were more often in persistent AF, had more frequently hypertension and diabetes, had higher CHA2 DS2 -VASc score, and had a number of failed antiarrhythmic drug (AAD). Periprocedural complication rates were similar among the three cohorts. The 12-month freedom from AF recurrence was 76.4% in the normal BMI group as compared to 79.2% in the overweight and 73.5% in the obese group (p = .35). However, 48% of overweight patients were on AAD treatment during the follow-up. By multivariate analysis, BMI was not a predictor for AF recurrence following the index CB-PVI. CONCLUSION: CB-PVI in obese patients is a safe procedure. Increased BMI (either moderate or severe) does not seem to be associated with a worse outcome or to a different rate of AAD discontinuation at 12 months.
BACKGROUND: Pulmonary veins isolation (PVI) by cryoballoon (CB) ablation is marginally represented in clinical studies in obese patients. The aim of this analysis was to evaluate the safety and efficacy of CB-PVI in a large cohort of overweight and obese patients from the 1STOP project. METHODS: From 2012 to 2018, 2048 patients with atrial fibrillation (AF) (70% male, 59 ± 11 years; 75% paroxysmal AF) underwent index CB-PVI. The patient data were separated into three cohorts for statistical evaluation, including: normal weight (body mass index [BMI] < 25 kg/m2 ), overweight (BMI = 25-30 kg/m2 ), and obese patients (BMI > 30 kg/m2 ). RESULTS: Out of 2048 patients, 693 (34%) patients had a BMI < 25 and were deemed as normal. There were 944 (46%) patients categorized as overweight (BMI = 25-30) and 411 (20%) as obese (BMI > 30). Overweight or obese patients were more often in persistent AF, had more frequently hypertension and diabetes, had higher CHA2 DS2 -VASc score, and had a number of failed antiarrhythmic drug (AAD). Periprocedural complication rates were similar among the three cohorts. The 12-month freedom from AF recurrence was 76.4% in the normal BMI group as compared to 79.2% in the overweight and 73.5% in the obese group (p = .35). However, 48% of overweight patients were on AAD treatment during the follow-up. By multivariate analysis, BMI was not a predictor for AF recurrence following the index CB-PVI. CONCLUSION: CB-PVI in obese patients is a safe procedure. Increased BMI (either moderate or severe) does not seem to be associated with a worse outcome or to a different rate of AAD discontinuation at 12 months.
Authors: Julian Wolfes; Daniel Hoppe; Christian Ellermann; Kevin Willy; Benjamin Rath; Patrick Leitz; Fatih Güner; Julia Köbe; Philipp S Lange; Lars Eckardt; Gerrit Frommeyer Journal: J Cardiovasc Dev Dis Date: 2022-08-17