Background

Obesity is associated with an increased incidence of atrial fibrillation (AF) and is increasing alarmingly in Western countries. Equally safe and effective procedures for the treatment of atrial fibrillation in obese patients are therefore needed. Cryoballoon ablation (CA) is established as a common procedure in a wide patient population but efficacy and safety data regarding obese patients are lacking.

Methods

We analyzed patients who underwent CA in a single-center cohort between 2018 and 2022. Follow-up was performed at 3, 6, 12, 18, 24 and 36 months after CA. Efficacy endpoint was symptomatic AF recurrence after 90-day blanking period. Safety endpoints were bleeding, major groin site complications, phrenic nerve injury, stroke or death for safety. Periprocedureal parameters were observed.

Results

Of 668 patients 493 had normal BMI (mean BMI 25.3±2.8kg/m²², age 70±10years, 56% male) while 175 patients (26.2%) suffered from obesity (mean BMI 33.4±3kg/m², age 67±10years, 56% male). At 36 months AF recurrence rate was similar for normal-weight and obese patients (45.3 % vs. 36.7%, P=0.13, Fig. A). Primary safety end point occurred in form of pericardial effusion or phrenic nerve injury in five patients with normal BMI (1.5%) and none obesity group. No deaths or strokes were observed in either group. Procedure time (54±16min vs. 57±16min, P=0.035), left- atrial dwell time (36±14min vs. 40±15min, P=0.003), fluoroscopy time (7±3min vs. 8±4min, P=0.004), contrast dye use (49±35ml vs. 60±42ml, P=0.001) and radiation dose (229±1176cGy*cm² vs. 512±651cGy*cm², P<0.001) were significantly higher in obese patients (Fig. B-E)

Conclusion

CA is a safe and effective treatment modality in obese patients but is associated with longer procedure times, higher radiation exposure and contrast dye use.