High-Power Short-Duration Ablation of Atrial Fibrillation is Feasible in Obese Patients without Significant Safety Risks

Viola Adam (Aalen)1, P. Biehler (Aalen)2, P. Hägele (Aalen)2, S. Hanger (Aalen)2, A. Pinchuk (Aalen)2, C. Wächter (Marburg)3, P. Seizer (Aalen)2, S. Weyand (Aalen)2

1Ostalb-Klinikum Aalen Pädiatrie Aalen, Deutschland; 2Ostalb-Klinikum Aalen Innere Medizin II, Kardiologie und Angiologie Aalen, Deutschland; 3Universitätsklinikum Giessen und Marburg GmbH Klinik für Innere Medizin - Schwerpunkt Kardiologie Marburg, Deutschland


Background: Pulmonary vein ablation is a common intervention obtaining rhythm control in atrial fibrillation. High Power Short Duration (HPSD) ablation has been shown to be feasible for atrial fibrillation (AF) with short procedure times. Overweight and obese patients represent a steadily increasing collective for pulmonary vein isolation. However, the base impedance, which might be altered in obese patients, is an important factor for the effectiveness of HPSD ablation.

182 consecutive patients with AF (paroxysmal and persistent) undergoing HPSD ablation in our center were retrospectively analyzed, of whom 63 patients had an BMI ≥ 30kg/m2 and 119 patients < 30kg/m². For ablation with HPSD we used a fixed protocol for energy delivery of 50 watts (contact force 3-20g). Two different mapping systems were used. Endpoint of ablation was complete pulmonary vein (PV) entrance and exit block controlled by a high-density catheter. In case of severe low voltage substrate additional ablation lines were created. The study aimed to compare safety and efficacy of HPSD ablation in obese patients with non-obese patients. 

Beside being significantly different in BMI (33.87 ± 3.74 kg/m2 vs. 25.50 ± 2.42 kg/m2, p<0.01) groups were comparable in age and other cardiovascular risk factors. Pulmonary vein entrance and exit block was successfully achieved in all patients. Base impedance (121 ± 15.9 Ω vs. 116.8 ± 16 Ω; p=0.13), procedure time (118 ± 26.6 min vs. 115.8 ± 32.8 min; p=0.66) and fluoroscopy time (15 ± 7.1 min vs. 13.6 ± 6.7 min; p=0.22) were similar comparing obese and non-obese patients. There was one case of pericardial tamponade, requiring intervention, in the obese group. Minor complications such as post-interventional pericarditis and vascular access complications appeared equally in both groups (3.2% vs 5%; p=0,72). There was no increased recurrence rate among obese patients (23.8% vs. 21%, p= 0,71). 

Conclusions: Our findings support the safety and efficacy of HPSD ablation as a viable treatment of AF in obese patients. Although patients with obesity and atrial fibrillation should be advised to reduce weight, obesity alone should not be used as an exclusion criterion for PVI on the basis of these data.
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