https://doi.org/10.1007/s00392-024-02526-y
1Christian-Albrechts-Universität zu Kiel Kiel, Deutschland; 2Universitätsklinikum Schleswig-Holstein Innere Medizin III mit den Schwerpunkten Kardiologie, Angiologie und internistische Intensivmedizin Kiel, Deutschland
Background:
The catheter ablation of atrial fibrillation (AF) in obese patients is associated with an increased recurrence rate as compared to non-obese patients. Pulmonary vein isolation (PVI) could be challenging due to the higher risk of complications during the intervention.
Aims:
The study aims to assess the patient characteristics, periprocedural data and safety of the de novo PVI of AF in obese vs non-obese patients in a tertiary center.
Methods:
All patients, who underwent de novo PVI with either radiofrequency (RF) energy or single shot devices (cryoballoon ablation or pulsed-field ablation (PFA) between 01/2022 and 01/2024 were prospectively included (n=381). Two groups were defined (obese group: body mass index (BMI) ≥ 30 kg/m2; n =120; non-obese group: BMI <30 kg/m2; n = 261) (Figure 1).
Results:
The obese patients were younger (p= 0.0002), had a higher prevalence of persistent AF (55% vs 40.6%, p=0.01), and had more comorbidities such as hypertension (90% vs 71.65, p<0.001) and Diabetes Mellitus (DM) (23.33% vs 11.88%, p=0.004) (Table 1). There were no differences in antiarrhythmic medication. Obese patients were more often anticoagulated with apixaban (p=0.007). For all procedures, fluoroscopy time was comparable (p=0.47), but procedure duration and radiation dose were higher (p=0.012 and p<0.001, respectively). In the analysis of the subgroups RF PVI vs single shot devices, more radiofrequency point-by-point ablation procedures with non-fluoroscopic mapping system procedures were done in the obese group. This strategy did not statistically significantly reduce the fluoroscopic time (10.35 [5.28; 19.75] vs 8.6 [2.2; 15.9] min, p=0.37 in obese patients with single shot vs RF). On the other hand, the duration of the procedure was longer in obese patients in the RF ablation group (p=0.016). That might reflect the higher complexity of the RF procedures in obese patients. The radiation dose was higher in obese patients for both single shot and RF ablation techniques (Table 2; Figure 2).
The periprocedural complication rate was not statistically different (Table 3). The rate of immediate AF recurrence (within 24 hours after the procedure) was the same in both groups (p=0.48). The rate of AF recurrence required hospital admission, and the rate of Re-do procedures did not differ in both groups.
Conclusion:
These data demonstrate that utilizing 3D mapping with point-by-point RF ablation in obese patients doesn’t significantly reduce the fluoroscopic dose but increases the procedure duration reflecting the higher procedure complexity as compared to non-obese patients. The safety profile and recurrence rate did not differ from those of non-obese patients.