Cryoablation for pulmonary veins isolation in obese patients with atrial fibrillation compared to nonobese patients

• Published in: Pacing and clinical electrophysiology Vol. 44; no. 2; pp. 306 - 317
• Main Authors: Malaspina, Daniele, Brasca, Francesco, Iacopino, Saverio, Arena, Giuseppe, Molon, Giulio, Pieragnoli, Paolo, Tondo, Claudio, Manfrin, Massimiliano, Rovaris, Giovanni, Verlato, Roberto, Dello Russo, Antonio, Startari, Umberto, Sgarito, Giuseppe, Perego, Giovanni Battista
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2021
• Subjects: Aged; atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - surgery; Body mass index; Body weight; Cardiac arrhythmia; cryoablation; Cryosurgery - adverse effects; Diabetes mellitus; Female; Fibrillation; Humans; Male; Middle Aged; Multivariate analysis; obese patients; Obesity; Obesity - complications; Overweight; Patients; pulmonary vein isolation; Pulmonary Veins - surgery; Retrospective Studies; Treatment Outcome; atrial fibrillation; obese patients; cryoablation; pulmonary vein isolation
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.14149

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 CHA2DS2‐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.