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Original research article
Impact of body mass index on the outcome of catheter ablation of atrial fibrillation
  1. Benedict M Glover1,
  2. Kathryn L Hong1,
  3. Nikolaos Dagres2,
  4. Elena Arbelo3,
  5. Cécile Laroche4,
  6. Sam Riahi5,6,
  7. Matteo Bertini7,
  8. Evgeny N Mikhaylov8,
  9. Joseph Galvin9,
  10. Marek Kiliszek10,
  11. Evgeny Pokushalov11,
  12. Josef Kautzner12,
  13. Naiara Calvo13,
  14. Carina Blomström-Lundqvist14,
  15. Josep Brugada3
  16. on behalf of the ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry investigators
    1. 1 Department of Cardiology, Queen’s University, Kingston, Ontario, Canada
    2. 2 Department of Electrophysiology, University Leipzig–Heart Center, Leipzig, Germany
    3. 3 Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
    4. 4 EURObservational Research Programme (EORP), European Society of Cardiology, Sophia Antipolis, France
    5. 5 Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
    6. 6 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
    7. 7 Department of Cardiology, S. Anna Hospital, University of Ferrara, Ferrara, Italy
    8. 8 Arrhythmia Department and Neuromodulation Unit, Almazov National Medical Research Centre, Saint-Petersburg, Russia
    9. 9 Cardiology Department, Mater Misericordiae University Hospital, Dublin, Ireland
    10. 10 Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
    11. 11 Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russia
    12. 12 Institute for Clinical and Experimental Medicine, Prague, Czech Republic
    13. 13 Cardiology Department, Clinica Universidad de Navarra, Pamplona, Spain
    14. 14 Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden
    1. Correspondence to Dr Benedict M Glover, Department of Cardiology, Queen’s University, Kingston ON K7L 3N6, Canada; benedict.glover{at}queensu.ca

    Abstract

    Objectives The association between obesity and atrial fibrillation (AF) is well-established. We aimed to evaluate the impact of index body mass index (BMI) on AF recurrence at 12 months following catheter ablation using propensity-weighted analysis. In addition, periprocedural complications and fluoroscopy details were examined to assess overall safety in relationship to increasing BMI ranges.

    Methods Baseline, periprocedural and follow-up data were collected on consecutive patients scheduled for AF ablation. There were no specific exclusion criteria. Patients were categorised according to baseline BMI in order to assess the outcomes for each category.

    Results Among 3333 patients, 728 (21.8%) were classified as normal (BMI <25.0 kg/m2), 1537 (46.1%) as overweight (BMI 25.5–29.0 kg/m2) and 1068 (32.0%) as obese (BMI ≥30.0 kg/m2). Procedural duration and radiation dose were higher for overweight and obese patients compared with those with a normal BMI (p=0.002 and p<0.001, respectively). An index BMI ≥30 kg/m2 led to a 1.2-fold increased likelihood of experiencing recurrent AF at 12-months follow-up as compared with overweight patients (HR 1.223; 95% CI 1.047 to 1.429; p=0.011), while no significant correlation was found between overweight and normal BMI groups (HR 0.954; 95% CI 0.798 to 1.140; p=0.605) and obese versus normal BMI (HR 1.16; 95% CI 0.965 to 1.412; p=0.112).

    Conclusions Patients with a baseline BMI ≥30 kg/m2 have a higher recurrence rate of AF following catheter ablation and therefore lifestyle modification to target obesity preprocedure should be considered in these patients.

    • atrial fibrillation
    • catheter ablation
    • obesity
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    Footnotes

    • Contributors All coauthors contributed equally to this publication.

    • Funding Since the start of EORP, the following companies have supported the programme: Abbott Vascular International (2011–2014), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2017), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe (2011–2020), The Alliance Daiichi Sankyo Europe and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter (2014–2016), Menarini International Operation (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2017), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2009–2018).

    • Competing interests ENM reports consultant fees from Biosense Webster, speaker’s bureau: Biosense Webster, Boehringer Ingelheim and Medtronic; MK reports teaching contract with Johnson & Jonhnson and with Abbott (formerly St. Jude Medical); ND reports grants from Biotronik, Abbott (formerly St Jude Medical) and Boston Scientific to the institution outside the submitted work.

    • Patient consent Not required.

    • Ethics approval All institutions who took part in this registry obtained approval from their individual REBs.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators Committees and Investigators Executive Committee: Nikolaos Dagres, Josep Brugada, Elena Arbelo,Luigi Tavazzi, Carina Blomström Lundqvist, Evgeny Pokushalov, Josef Kautzner, Aldo P. Maggioni. Steering Committee (National Coordinators): Clemens Steinwender, Alexandr Chasnoits, Georges Mairesse, Tosho Balabanski, Josef Kautzner, Sam Riahi, Mostafa Nawar, Mervat Abul El Maaty, Pekka Raatikainen, Frederic Anselme, Thorsten Lewalter, Turgut Brodherr, Michalis Efremidis, Laszlo Geller, Ben Glover, Roy Beinart,Michael Glikson, Fiorenzo Gaita, Roin Rekvava, Oskars Kalejs, SergeTrines, Zbigniew Kalarus, Mario Martins Oliveira, Pedro Adragao, Radu Ciudin, Evgeny Mikhaylov, Matjaz Sinkovec, Julian Perez Villacastin,Carina Blomström-Lundqvist, Oleg Sychov, Paul Roberts. Investigators: Austria, Graz D Daniel Scherr; Martin Manninger;Bernadette Mastnak; Innsbruck Otamr Pachinger; Florian Hintringer; Markus Stühlinger; Linz Clemens Steinwender;Belgium, Yvoir Olivier Xhaet; Bulgaria, Sofia Tchavdar Shalganov; Milko Stoyanov; Mihail Protich; Sofia Vassil Traykov; Daniel Marchov; Genadi Kaninski; BELARUS Minsk Alexandr Chasnoits; Czech Republic, Prague Robert Cihak;Hradec Kralove Ludek Haman; Germany, Frankfurt Boris Schmidt; K.R. Julian Chun; Laura Perrotta; Stefano Bordignon;Hamburg Roland Tilz; Hamburg Stephan Willems; Leipzig Gerhard Hindricks; München Turgut Brodherr; Ilia S.Koutsouraki; Thorsten Lewalter; Denmark, Aalborg Sam Riahi; Bodil Ginnerup Sørensen; Egypt, Cairo Wagdi Galal; Cairo Amir Abdel Wahab; Cairo S Sherif Mokhtar; Spain, Alicante Ignacio Gil Ortega; Juan Gabriel Martinez Martinez; Badajoz Manuel Doblado Calatrava; Barcelona Roger Villuendas Sabate; Barcelona Lluis Mont Girbau;Bilbao Maria Fe Arcocha; Larraitz Gaztañaga; Estibaliz Zamarreño; Granada Miguel Álvarez; Rosa Macías; LasPalmas de Gran Canaria Federico Segura Villalobos; Juan Carlos Rodríguez Pérez; Madrid Nicasio Perez Castellano; Victoria Cañadas; Juan J Gonzalez Ferrer; David Filgueiras; Madrid Jose Manuel Rubio Campal; Pepa Sánchez-Borque; Juan Benezet-Mazuecos; Madrid Jorge Toquero Ramos; FernandezLozano; Victor Castro Urda; Malaga Alberto Barrera Cordero;Carmen Medina Palomo; Amalio Ruiz-Salas; Javier Alzueta; Madrid Rafael Peinado; David Filqueiras-Rama; Alfonso Gómez Gallanti;Daniel Garófalo; Pamplona Naiara Calvo; Santander JuanJ ose Olalla Antolin; Sevilla Alonso Pedrote; Eduardo Arana-Rueda; Lorena García-Riesco; Finland, Turku Juha Lund; Tampere Pekka Raatikainen; France, Grenoble Pascal Defaye; Peggy Jacon; Sandrine Venier; Florian Dugenet; SaintDenis Olivier Piot; Xavier Copie; Olivier Paziaud; Antoine Lepillier; Saint Etienne Antoine Da Costa; Cécile Romeyer-Bouchard; Toulouse Serge Boveda; Jean-Paul Albenque;Nicolas Combes; Stéphane Combes Marseille AngeFerracci; André Pisapia; Greece, Athens Demosthenes Katritsis; Athens Konstantinos Letsas; Kostas Vlachos; Louiza Lioni; Thessaloniki Vassilios P. Vassilikos; Hungary, Budapest Laszlo Geller, Nándor Szegedi; Gábor Széplaki;Tamás Tahin; Debrecen Zoltan Csanadi; Gabor Sandorfi;Alexandra Kiss; Edina Nagy-Balo; Szeged Laszlo Saghy; Ireland, Dublin Benedict M. Glover; Joseph Galvin; Edward Keelan; Israel, Ramat Roy Beinart; Michael Glikson; Eyal Nof; Italy, Acquaviva delle Fonti Massimo Grimaldi; Federico Quadrini; Antonio Di Monaco; Federica Troisi; Castellanza Massimo Tritto; Elvira Renzullo; Antonio Sanzo; Domenico Zagari;Cotignola Carlo Pappone; Crema Pietro Maria Giovanni Agricola; Milano Paolo Della Bella; Napoli Giuseppe Stabile; Assunta Iuliano; Pisa Maria Grazia Bongiorni; Roma Leonardo Calo; Ermenegildo de Ruvo; Luigi Sciarra; Torino Matteo Anselmino; Fiorenzo Gaita; Federico Ferraris; Varese Roberto De Ponti; Raffaella Marazzi; Lorenzo A. Doni; Kazakhstan, Almaty Roin Rekvava; Anna Kim; Latvia, Riga Oskars Kalejs; Netherlands, Breda Sander Molhoek;Groningen Isabelle Van Gelder; Michiel Rienstra; Leiden Serge Trines; Marieke G. Compier; Maastricht Laurent Pison; Harry J. Crijns; Kevin Vernooy; Justin Luermans; Rotterdam LucJordaens; Natasja de Groot; Tamas Szili-Torok; Rohit Bhagwandien;Zwolle Arif Elvan; Thomas Buist; Pim Gal; Poland, Lodz Andrzej Lubinski; Gdansk Tomasz Krolak; Katowice Seweryn Nowak, Katarzyna Mizia-Stec; Anna Maria Wnuk-Wojnar;Krakow Jacek Lelakowski; Szczecin Jaroslaw Kazmierczak;Warszawa Piotr Kulakowski; Jakub Baran; Warszawa Grzegorz Opolski; Marek Kiliszek; Piotr Lodziński; Sonia Borodzicz;Paweł Balsam; Poznan Krzysztof Blaszyk; Warszawa Mariusz Pytkowski; Rafal Kuteszko; Jan Ciszewski; Wroclaw Artur Fuglewicz; Zabrze Zbigniew Kalarus; Aleksandra Woźniak;Karolina Adamczyk; Portugal, Carnaxide Lisboa Pedro Adragao; Lisboa Pedro Cunha; Romania, Iasi Mihaela Grecu; Grigore Tinica; Cluj-Napoca Lucian Muresan; Radu Rosu; Russian Federation, Kemerovo Egor Khomenko;Khanty-Mansiysk Nikita Scharikov; Krasnoyarsk Dmitry Zamanov; Krasnoyarsk Evgenii Kropotkin; Novosibirsk Evgeny Pokushalov; Alexander Romanov; Sevda Bayramova;Saint-Petersburg Evgeny N. Mikhaylov; Dmitry S. Lebedev; Anna V. Patsouk; Saint-Petersburg Sergey Yashin; Saint-Petersburg Dmitry Kryzhanovskiy; Saransk Vyacheslav Bazayev; Surgut Denis Morgunov; Ilya Silin; Tomsk Sergey Popov; Tyumen Vadim Kuznetsov; Swedon, Linköping Anders Jönsson;Lund Pyotr Platonov; Fredrik Holmqvist; Ole Kongstad; ShiwenYuan; Umeå Niklas Höglund; Uppsala Helena Malmborg;David Mörtsell; Slovenia, Ljubljana Matjaz Sinkovec;Andrej Pernat; United Kingdom, Southampton John Morgan; Paul Roberts; Elizabeth F. Greenwood; Lisa L. Fletcher; Ukraine, Donetsk Tetiana Kravchenko; Kiev Alexander Doronin; Maryna Meshkova; Odessa Iurii Karpenko; Alex Goryatchiy; Anna Abramova.

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