Obesity is associated with impaired long-term success of pulmonary vein isolation: a plea for risk factor management before ablation

Abstract

Aims Obesity is an increasing health problem and is an important risk factor for the development of atrial fibrillation (AF). We investigated the association of body mass index (BMI) on the safety and long-term efficacy of pulmonary vein isolation (PVI) for drug-refractory AF. Methods 414 consecutive patients who underwent transcatheter PVI for AF between 2003 and 2013 were included. Successful PVI was defined as absence of atrial arrhythmia on Holter monitoring or ECG, without and with antiarrhythmic drugs during follow-up. Obesity was defined as BMI≥30 kg/m². Results Mean age was 56±10 years, 316 (76%) were male, 311 (75%) had paroxysmal AF and 111 (27%) were obese. After a mean follow-up of 46±32 months (1590 patient-years), freedom from atrial arrhythmia and antiarrhythmic drugs was significantly lower in patients with obesity compared with non-obese patients (30% vs 46%, respectively, P=0.005, log-rank 0.016). With antiarrhythmic drugs, freedom from atrial arrhythmia was 56% vs 68% (P=0.036). No differences in minor and major adverse events were observed between patients with obesity and non-obese patients (major 6% vs 3%, P=0.105, and minor 5% vs 5%, P=0.512). Sensitivity analyses demonstrated that BMI (as continuous variable) was associated with PVI outcome (HR 1.08, 95% CI 1.02 to 1.14, P=0.012). Conclusion Obesity is associated with reduced efficacy of PVI for drug-refractory AF. No relation between obesity and adverse events was found. IntRoduCtIon Transcatheter pulmonary vein isolation (PVI) using radiofrequency energy is a widespread and well-established technique for the treatment of atrial fibrillation (AF). 1-3 Current guidelines indicate that PVI should be considered even before antiarrhythmic drugs (AADs) have failed in patients with paroxysmal AF. 2 Catheter ablation is superior to AADs for rhythm control in symptomatic paroxysmal AF 4-6 and can also be performed successfully for persistent or long-standing