Abstract 93 Impact of Body Mass Index on Cryoablation of atrial fibrillation: Patient characteristics, procedural data and long-term outcomes <BR>

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Impact of Body Mass Index on Cryoablation of atrial fibrillation: Patient characteristics, procedural data and long-term outcomes
L. Urbanek¹, S. Bordignon¹, S. Chen¹, F. Bologna¹, S. Tohoku¹, B. Schmidt¹, K. R. J. Chun¹
¹Medizinische Klinik III - CCB, Agaplesion Markus Krankenhaus, Frankfurt am Main;
Background: Body mass index (BMI) can reduce efficacy and safety of ablation of atrial fibrillation. Purpose of this study was to evaluate the influence of BMI on procedural and chronic success in obese patients with symptomatic atrial fibrillation undergoing cryoaballon pulmonary vein isolation (PVI). Methods: Patients with a BMI≥25 and symptomatic AF (paroxysmal/persistent AF) who underwent cryoballon ablation were retrospectively enrolled and divided into three groups (G1: BMI of 25-29 kg/m2, G2: BMI of 30-34 kg/m2; G3: BMI≥35 kg/m2). All patients were treated with the 28 mm CB. Procedural data, complications and success rate at one year were compared among the three groups. All procedures were performed in conscious sedation. Procedural endpoint was electrical pulmonary vein isolation. Clinical success was defined as no recurrence of AF/atrial tachycardia (AT). Results: Six hundred patients were included (59% male, mean age 66±11 years); 337, 149, 114 were assigned to G1, G2 and G3, respectively. As far as it concerns the procedural data, procedural time (58±20 minutes to 63±24 minutes, p=0,258) and fluoroscopy time (9,3±6 minutes to 10,6±6 minutes, p=0,072) both increased slightly from G1 to G3 without statistical significance whereas radiation dose increased significantly from 1286±898 uGym2 to 3080±2266 uGym2 (p<0,001). The overall freedom from AF after 1-year was 77%. For paroxysmal AF it was 81,7% and 69,5% in persistent AF (p<0,001). Patients with an BMI≥35 (G3) had a significantly worse 1-year success rate (66,5%) compared to patients in the other two groups (G1: 78,4%; p=0,015 and G2: 82,5%; p=0,008). The difference between G1 and G2 was not significant (p=0,31). This difference between patients in G3 compared to the other groups was also found in patients with paroxysmal AF (recurrence free survival after one year in G1 of 84,0%, G2 of 86,3% and G3 of 69,6%). In patients with persistent AF the analysis showed no significant difference in recurrence free survival after one year between the groups (G1 of 68,7%, G2 of 77,4% and G3 of 62,1%). The difference in freedom from recurrence between paroxysmal and persistent AF was significant in G 1 (84% vs. 68,7%; p<0,001) and G 2 (86,3% vs. 77,4%; p=0,032) but not in G 3 (69,6% vs. 62,1%; p=0,501). With 4,7 % the overall complication rate was low but rose from 3% in G1 to 5,4% in G2 and was 8,8% in G3 with a statistically significant difference (p=0,01) but stayed on a low level. Nearly half of the complication in G3 (4/10) were due to complications at the access site (ateriovenosus fistula or pseudoaneurysm at access site). Conclusion Cryoballoon ablation of atrial fibrillation in the context of obesity showed a high efficacy. Patients with severe obesity showed a reduced safety profile and success rate after CB ablation, led by a significant lower success rate in the paroxysmal form of AF. In association with life style modification, CB ablation may represent a strategy to enhance rhythm control in the context of obesity.
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