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Jurica J, Péč MJ, Benko J, Bolek T, Galajda P, Mokáň M, Samoš M. Obesity as a risk factor in atrial fibrillation and heart failure. J Diabetes Metab Disord 2024; 23:125-134. [PMID: 38932866 PMCID: PMC11196522 DOI: 10.1007/s40200-023-01332-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/10/2023] [Indexed: 06/28/2024]
Abstract
Objectives The aim of this article is to provide an insight into the role of obesity as a risk factor, and as a potential etiologic agent of atrial fibrillation (AF) and heart failure (HF). Methods A narrative (non-systematic) review article summarizing currently available data regarding the interaction between obesity, AF and HF. Results Obesity is considered a risk factor of AF and chronic HF. Multiple recent studies indicate that obesity is also a potential causal factor in the development of AF and HF, the elucidation of pathological mechanisms of which could help devise new diagnostic and therapeutic modalities for these conditions. The discussion about obesity in relation to HF cannot omit the so-called obesity paradox, which represents a dilemma for clinicians, and it is still a source of irregularities regarding the strategy of weight reduction in obese patients with HF. Recently, the obesity paradox has also been assumed to play a role in the relationship between obesity and thromboembolic complications of AF. Conclusions Obesity is an independent and modifiable risk factor for AF and HF. In addition, there is an increasing volume of experimental and clinical data that suggests an important role of the epicardial adipose tissue in the pathophysiology of AF. However, several issues, such as the issue of optimal pharmacotherapy and weight reduction strategy in obese patients with HF remains still unanswered, and open for future investigation.
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Affiliation(s)
- Jakub Jurica
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovak Republic
| | - Martin Jozef Péč
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovak Republic
| | - Jakub Benko
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovak Republic
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovak Republic
| | - Peter Galajda
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovak Republic
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovak Republic
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovak Republic
- Division of Acute and Interventional Cardiology, Department of Cardiology and Angiology II, Mid-Slovakian Institute of Heart and Vessel Diseases (SÚSCCH) in Banská Bystrica, Banská Bystrica, Slovakia
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2
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Folli F, Centofanti L, Magnani S, Tagliabue E, Bignotto M, La Sala L, Pontiroli AE. Obesity effect on newly diagnosed and recurrent post-ablation atrial fibrillation: a systematic review and meta-analysis. J Endocrinol Invest 2024; 47:1051-1066. [PMID: 37962809 DOI: 10.1007/s40618-023-02225-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND AND AIMS The role of overweight and obesity in the development of atrial fibrillation (AF) is well established; however, the differential effect on the occurrence and recurrence of AF remains uncertain. The aim of this review is to compare the effect of underweight and varying degrees of obesity on onset of AF and in recurrent post-ablation AF, and, when possible, in relation to sex. METHODS A systematic literature search was conducted in PubMed, Embase, and Cochrane Library from inception to January 31, 2023. Studies reporting frequency of newly-diagnosed AF and of recurrent post-ablation AF in different BMI categories, were included. 3400 records were screened and 50 met the inclusion criteria. Standardized data search and abstraction were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. Data were extracted from the manuscripts and were analyzed using a random effect model. The outcome was the occurrence of AF in population studies and in patients undergoing ablation. RESULTS Data from 50 studies were collected, of which 27 for newly-diagnosed AF and 23 for recurrent post-ablation AF, for a total of 15,134,939 patients, of which 15,115,181 in studies on newly-diagnosed AF and 19,758 in studies on recurrent post-ablation AF. Compared to normal weight, the increase in AF was significant (p < 0.01) for overweight, obese, and morbidly obese patients for newly-diagnosed AF, and for obese and morbidly obese patients for recurrent post-ablation AF. Newly-diagnosed AF was more frequent in obese female than obese male patients. CONCLUSION The effect of increased BMI was greater on the onset of AF, and obese women were more affected than men.
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Affiliation(s)
- F Folli
- Department of Health Sciences, University of Milan, Via A. Di Rudinì 8, 20142, Milan, Italy.
| | - L Centofanti
- Department of Health Sciences, University of Milan, Via A. Di Rudinì 8, 20142, Milan, Italy
| | - S Magnani
- Division of Cardiology, Ospedale San Paolo, 20142, Milan, Italy
| | - E Tagliabue
- Laboratory of Cardiovascular and Dysmetabolic Diseases, PST-Via Fantoli 18/15, 20138, Milan, Italy and Value-Based Healthcare Unit, IRCCS MultiMedica, 20099, Sesto San Giovanni, Milan, Italy
| | - M Bignotto
- Department of Health Sciences, University of Milan, Via A. Di Rudinì 8, 20142, Milan, Italy
| | - L La Sala
- Laboratory of Cardiovascular and Dysmetabolic Diseases, PST-Via Fantoli 18/15, 20138, Milan, Italy and Value-Based Healthcare Unit, IRCCS MultiMedica, 20099, Sesto San Giovanni, Milan, Italy
| | - A E Pontiroli
- Department of Health Sciences, University of Milan, Via A. Di Rudinì 8, 20142, Milan, Italy.
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3
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Marzak H, Fitouchi S, Labani A, Hammann J, Ringele R, Kanso M, Cardi T, Schatz A, Ohlmann P, Morel O, Jesel L. Left atrial remodeling and voltage-guided ablation outcome in obese patients with persistent atrial fibrillation. Front Cardiovasc Med 2024; 11:1362903. [PMID: 38628316 PMCID: PMC11018888 DOI: 10.3389/fcvm.2024.1362903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Background Obesity is a risk factor for atrial fibrillation (AF). Data regarding left atrial (LA) remodeling in obese patients are scarce. Whether obesity favors AF recurrence after catheter ablation (CA) is still controversial. We assessed the distribution of epicardial atrial fat on computed tomography (CT), LA bipolar voltage, low-voltage zone (LVZ) extent, and the outcome of voltage-guided ablation of persistent AF in obese and non-obese patients. Methods A total of 139 patients with persistent AF undergoing a first voltage-guided ablation were enrolled and divided into two groups: 74 were non-obese and 65 were obese. Epicardial adipose tissue (EAT) was assessed on a CT scanner. LA endocardial voltage maps were obtained using a 3D mapping system in sinus rhythm. LVZ was defined as a bipolar peak-to-peak voltage amplitude <0.5 mV. Results LA volume, voltage, and EAT amount were similar in the two groups. LVZ was less frequent in obese patients [12 (18.8%) vs. 26 (35.1%), p = 0.05], particularly on the anterior wall. The posterior and lateral EATs were correlated with posterior and lateral LVZ extent, respectively, in obese patients. After 36 months of follow-up, the AF-free survival rate was similar. Lateral EAT [odds ratio (OR) 1.21, 95% confidence interval (CI) 1-1.4, p = 0.04] and P-wave duration (OR 1.03, 95% CI 1-1.05, p = 0.03), but not body mass index (BMI), were predictors of AF recurrence after CA. Conclusion In obese patients, LVZ was less marked than in non-obese patients with similar LA volumes, voltage, and EAT amounts. In obese patients, posterior and lateral EATs were correlated with posterior and lateral LVZ extents. Obese patients had a similar and favorable 36-month outcome after AF ablation. BMI was not predictive of AF recurrence.
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Affiliation(s)
- Halim Marzak
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Simon Fitouchi
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Aïssam Labani
- Department of Radiology, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Justine Hammann
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Romain Ringele
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Mohamad Kanso
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Thomas Cardi
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Alexandre Schatz
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Patrick Ohlmann
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
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5
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Lee PL, Wu YW, Cheng HM, Wang CY, Chuang LP, Lin CH, Hang LW, Yu CC, Hung CL, Liu CL, Chou KT, Su MC, Cheng KH, Huang CY, Hou CJY, Chiu KL. Recommended assessment and management of sleep disordered breathing in patients with atrial fibrillation, hypertension and heart failure: Taiwan Society of Cardiology/Taiwan Society of sleep Medicine/Taiwan Society of pulmonary and Critical Care Medicine joint consensus statement. J Formos Med Assoc 2024; 123:159-178. [PMID: 37714768 DOI: 10.1016/j.jfma.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/23/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
Sleep disordered breathing (SDB) is highly prevalent and may be linked to cardiovascular disease in a bidirectional manner. The Taiwan Society of Cardiology, Taiwan Society of Sleep Medicine and Taiwan Society of Pulmonary and Critical Care Medicine established a task force of experts to evaluate the evidence regarding the assessment and management of SDB in patients with atrial fibrillation (AF), hypertension and heart failure with reduced ejection fraction (HFrEF). The GRADE process was used to assess the evidence associated with 15 formulated questions. The task force developed recommendations and determined strength (Strong, Weak) and direction (For, Against) based on the quality of evidence, balance of benefits and harms, patient values and preferences, and resource use. The resulting 11 recommendations are intended to guide clinicians in determining which the specific patient-care strategy should be utilized by clinicians based on the needs of individual patients.
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Affiliation(s)
- Pei-Lin Lee
- Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Wen Wu
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Division of Faculty Development, Taipei Veterans General Hospital, Taipei, Taiwan; PhD Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Cheng-Yi Wang
- Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Li-Pang Chuang
- Sleep Center, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, Chang Gung University, Tauyan, Taiwan
| | - Chou-Han Lin
- Division of Respirology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Liang-Wen Hang
- School of Nursing & Graduate Institute of Nursing, China Medical University, Taichung, Taiwan; Sleep Medicine Center, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Chieh Yu
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Lieh Hung
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Biomedical Sciences, Mackay Medical College, Taipei, Taiwan
| | - Ching-Lung Liu
- Division of Chest, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Kun-Ta Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mao-Chang Su
- Sleep Center, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Kai-Hung Cheng
- Kao-Ho Hospital, Kaohsiung, Taiwan; Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Charles Jia-Yin Hou
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan.
| | - Kuo-Liang Chiu
- Division of Chest Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.
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6
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Molina-Ramos AI, Ruiz-Salas A, Medina-Palomo C, Becerra-Muñoz V, Rodríguez-Capitán J, Romero-Cuevas M, Carmona-Segovia A, Fernández-Lozano I, Gómez-Doblas JJ, Jiménez-Navarro M, Pavón-Morón FJ, Barrera-Cordero A, Alzueta-Rodríguez J. Index and Repeat Ablation for Atrial Fibrillation in Older versus Younger Patients: A Propensity-Score Matching Analysis. Aging Dis 2024; 15:408-420. [PMID: 37307839 PMCID: PMC10796093 DOI: 10.14336/ad.2023.0511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/11/2023] [Indexed: 06/14/2023] Open
Abstract
Catheter ablation is a well-established rhythm control therapy in atrial fibrillation (AF). Although the prevalence of AF increases dramatically with age, the prognosis and safety profile of index and repeat ablation procedures remain unclear in the older population. The primary endpoint of this study was to assess the arrhythmia recurrence, reablation and complication rates in older patients. Secondary endpoints were the identification of independent predictors of arrhythmia recurrence and reablation, including information on pulmonary vein (PV) reconnection and other atrial foci. Older (n=129, ≥70 years) and younger (n=129, <70 years) patients were compared using a propensity-score matching analysis based on age, gender, obesity, hypertension, dyslipidemia, diabetes mellitus, dilated left atrium, severe obstructive sleep apnea, cardiac disease, left systolic ventricular function, AF pattern and ablation technique. Arrhythmia recurrence and reablation were evaluated in both groups using a Cox regression analysis in order to identify predictors. During a 30-month follow-up period, there were no significant differences between older and younger patients in the arrhythmia-free survival (65.1% and 59.7%; log-rank test p=0.403) and complication (10.1% and 10.9%; p>0.999) rates after the index ablation. However, the reablation rate was significantly different (46.7% and 69.2%; p<0.05, respectively). In those patients who underwent reablation procedure (redo subgroups), there were no differences in the incidence of PV reconnection (38.1% redo-older and 27.8% redo-younger patients; p=0.556). However, the redo-older patients had lower reconnected PVs per patient (p<0.01) and lower atrial foci (2.3 and 3.7; p<0.01) than the redo-younger patients. A further important finding was that age was not an independent predictor of arrhythmia recurrence or reablation. Our data reveal that the AF index ablation in older patients had a similar efficacy and safety profile to younger patients. Therefore, age alone must not be considered a prognostic factor for AF ablation but the presence of limiting factors such as frailty and multiple comorbidities.
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Affiliation(s)
- Ana Isabel Molina-Ramos
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, 29010 Málaga, Spain.
- Cardiología y Cirugía Cardiovascular-Área del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Amalio Ruiz-Salas
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, 29010 Málaga, Spain.
- Cardiología y Cirugía Cardiovascular-Área del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Unidad de Arritmias, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
| | - Carmen Medina-Palomo
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, 29010 Málaga, Spain.
- Cardiología y Cirugía Cardiovascular-Área del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Unidad de Arritmias, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
| | - Víctor Becerra-Muñoz
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, 29010 Málaga, Spain.
- Cardiología y Cirugía Cardiovascular-Área del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Jorge Rodríguez-Capitán
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, 29010 Málaga, Spain.
- Cardiología y Cirugía Cardiovascular-Área del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Miguel Romero-Cuevas
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, 29010 Málaga, Spain.
- Cardiología y Cirugía Cardiovascular-Área del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Ada Carmona-Segovia
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, 29010 Málaga, Spain.
- Cardiología y Cirugía Cardiovascular-Área del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Ignacio Fernández-Lozano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Madrid, Spain
| | - Juan José Gómez-Doblas
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, 29010 Málaga, Spain.
- Cardiología y Cirugía Cardiovascular-Área del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Manuel Jiménez-Navarro
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, 29010 Málaga, Spain.
- Cardiología y Cirugía Cardiovascular-Área del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Francisco Javier Pavón-Morón
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, 29010 Málaga, Spain.
- Cardiología y Cirugía Cardiovascular-Área del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Alberto Barrera-Cordero
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, 29010 Málaga, Spain.
- Cardiología y Cirugía Cardiovascular-Área del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Unidad de Arritmias, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
| | - Javier Alzueta-Rodríguez
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, 29010 Málaga, Spain.
- Cardiología y Cirugía Cardiovascular-Área del Corazón, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Unidad de Arritmias, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
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Limpitikul WB, Das S. Obesity-Related Atrial Fibrillation: Cardiac Manifestation of a Systemic Disease. J Cardiovasc Dev Dis 2023; 10:323. [PMID: 37623336 PMCID: PMC10455513 DOI: 10.3390/jcdd10080323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with increased morbidity and mortality. The mechanisms underlying AF are complex and multifactorial. Although it is well known that obesity is a strong risk factor for AF, the mechanisms underlying obesity-related AF are not completely understood. Current evidence proposes that in addition to overall hemodynamic changes due to increased body weight, excess adiposity raises systemic inflammation and oxidative stress, which lead to adverse atrial remodeling. This remodeling includes atrial fibrosis, atrial dilation, decreased electrical conduction between atrial myocytes, and altered ionic currents, making atrial tissue more vulnerable to both the initiation and maintenance of AF. However, much remains to be learned about the mechanistic links between obesity and AF. This knowledge will power the development of novel diagnostic tools and treatment options that will help combat the rise of the global AF burden among the obesity epidemic.
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Affiliation(s)
- Worawan B. Limpitikul
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Saumya Das
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
- Demoulas Family Foundation Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA 02114, USA
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8
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Liu F, Song T, Hu Q, Zhu X, Zhao H, Tan Z, Yu P, Ma J, Luo J, Liu X. Body mass index and atrial fibrillation recurrence post ablation: A systematic review and dose-response meta-analysis. Front Cardiovasc Med 2023; 9:999845. [PMID: 36818915 PMCID: PMC9932032 DOI: 10.3389/fcvm.2022.999845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/29/2022] [Indexed: 02/05/2023] Open
Abstract
Objectives The aim of this study was to evaluate the shape of the dose-response relationship between body mass index (BMI) and atrial fibrillation (AF) recurrence in patients who have undergone radiofrequency ablation. Methods Studies investigating BMI and AF recurrence in patients with AF after ablation were identified through electronic searches in the PubMed, EMBASE, and Cochrane Library databases. The potential non-linear relationship was fitted using robust error meta-regression. Our study was registered with PROSPERO (CRD42019121373). Results Twenty-six cohort studies with 7,878 cases/26,450 individuals were included, and a linear dose-response relationship between BMI and AF recurrence (P non-linearity = 0.12) was found. The risk of AF recurrence in patients with a BMI over 28 was significantly increased. Specifically, for each 5 kg/m2 increase in BMI, the risk of AF recurrence increased by 15% (95% CI: 1.08-1.22) with moderate heterogeneity (I 2 = 53%). Subgroup analyses showed that the pooled risk ratio was not significantly changed in subgroup analysis adjustment for the following important potential intermediate factors: left atrial diameter and obstructive sleep apnea. Conclusion This study showed that there is a borderline positive linear association between BMI and AF recurrence post ablation. Overweight and obesity are significantly associated with AF recurrence. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42019128770.
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Affiliation(s)
- Fuwei Liu
- Department of Cardiology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Tiangang Song
- Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qingwen Hu
- Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xin Zhu
- Department of Cardiology, The First People’s Hospital of Yulin, Yulin, Guangxi, China
| | - Huilei Zhao
- Department of Anesthesia, The Third People’s Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Ziqi Tan
- Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Peng Yu
- Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Jun Luo
- Department of Cardiology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China,*Correspondence: Jun Luo,
| | - Xiao Liu
- Department of Cardiology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
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9
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Zhang D, Ma Y, Xu J, Yi F. Association between obstructive sleep apnea (OSA) and atrial fibrillation (AF): A dose-response meta-analysis. Medicine (Baltimore) 2022; 101:e29443. [PMID: 35905270 PMCID: PMC9333485 DOI: 10.1097/md.0000000000029443] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Refractory hypoxemia episodes are characteristic of obstructive sleep apnea (OSA). Patients with OSA suffer from oxidative stress in all systems. Atrial fibrillation (AF) is a type of arrhythmia that may be induced by OSA. In this study, we explored the dose-response relationship between OSA and AF. Our research provides the basis for a novel approach to AF prevention. METHODS We screened four databases (PubMed, Embase, the Cochrane Library, and Web of Science) for observational studies on OSA and AF. Studies were collected from database establishment to November 2020. We performed a traditional subgroup meta-analysis. Linear and spline dose-response models were applied to assess the association between the apnea-hypopnea index, an indicator of OSA severity, and the risk of AF. Review Manager version 5.3 software and Stata 16.0 were used for the analysis. RESULTS Sixteen observational studies were included in the study. We excluded a study from the conventional meta-analysis. In the subgroup analysis, the odds ratios for new onset AF for no obvious reason, new onset AF after surgical operations, such as coronary artery bypass grafting, and AF after ablation treatment were 1.71 (95% CI 1.37-2.13, P < .05), 2.65 (95% CI 2.32-3.01, P < .05), and 2.93 (95% CI 2.47-3.49, P < .05), respectively. Linear dose-response meta-analysis results revealed that the risk of AF increased with increasing apnea-hypopnea index value. CONCLUSION Through dose-response meta-analysis, we found a potential dose-response relationship between OSA severity and the risk of AF. This relationship should be considered in interventions aimed at AF prevention in the future.
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Affiliation(s)
- Dong Zhang
- Department of Cardiology, Xijing Hospital, The Air Force Military Medical University, Xi’an Shaanxi, China.Supplemental Digital Content is available for this article
| | - Yibo Ma
- Department of Cardiology, Xijing Hospital, The Air Force Military Medical University, Xi’an Shaanxi, China.Supplemental Digital Content is available for this article
| | - Jian Xu
- Department of Cardiology, Xijing Hospital, The Air Force Military Medical University, Xi’an Shaanxi, China.Supplemental Digital Content is available for this article
| | - Fu Yi
- Department of Cardiology, Xijing Hospital, The Air Force Military Medical University, Xi’an Shaanxi, China.Supplemental Digital Content is available for this article
- *Correspondence: Fu Yi, Department of Cardiology, Xijing Hospital, The Air Force Military Medical University, Xi’an Shaanxi 710032, China (e-mail: )
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10
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Lifestyle Modification and Atrial Fibrillation: Critical Care for Successful Ablation. J Clin Med 2022; 11:jcm11092660. [PMID: 35566788 PMCID: PMC9099891 DOI: 10.3390/jcm11092660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023] Open
Abstract
Management of atrial fibrillation (AF) requires a comprehensive approach due to the limited success of medical or procedural approaches in isolation. Multiple modifiable risk factors contribute to the development and progression of the underlying substrate, with a heightened risk of progression evident with inadequate risk factor management. With increased mortality, stroke, heart failure and healthcare utilisation linked to AF, international guidelines now strongly support risk factor modification as a critical pillar of AF care due to evidence demonstrating the efficacy of this approach. Effective lifestyle management is key to arrest and reverse the progression of AF, in addition to increasing the likelihood of freedom from arrhythmia following catheter ablation.
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11
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Mitrani LR, Goldenthal I, Leskowitz J, Wan EY, Dizon J, Saluja D, Creber RM, Turchioe MR, Sciacca RR, Garan H, Hickey KT, Korner J, Biviano AB. Risk factor management of atrial fibrillation using mHealth: The Atrial Fibrillation – Helping Address Care with Remote Technology (AF-HEART) Pilot Study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 3:14-20. [PMID: 35265931 PMCID: PMC8890079 DOI: 10.1016/j.cvdhj.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Personalized treatment of atrial fibrillation (AF) risk factors using mHealth and telehealth may improve patient outcomes. Objective The purpose of this study was to assess the feasibility of the Atrial Fibrillation Helping Address Care with Remote Technology (AF-HEART) intervention on the following patient outcomes: (1) heart rhythm tracking; (2) weight, alcohol, blood pressure (BP), and sleep apnea reduction; (3) AF symptom reduction; and (4) quality-of-life (QOL) improvement. Methods A total of 20 patients with AF undergoing antiarrhythmic therapy, cardioversion, and/or catheter ablation were enrolled and followed for 6 months. The AF-HEART intervention included remote heart rhythm, weight, and BP tracking; televisits with a dietician focusing on AF risk factors; and referrals for sleep apnea and hypertension treatment. Results Patients transmitted a median of 181 rhythm recordings during the 6-month follow-up period. Patients lost an average of 3.5 kilograms at 6 months (P = .005). Patients had improved SF-12 scores (P = .01), AFSS score (P = .01), EQ-5D score (P = .006), and AFEQT Global Score (P = .03). There was significant correlation between weight loss and decrease in symptom severity (r = -0.45, P = .05), and between % weight loss and decrease in symptom severity (r = -0.49, P = .03). Conclusion This study described the feasibility of the AF-HEART intervention for (1) consistent remote tracking of heart rhythm, weight, and BP; (2) achievement of weight loss; (3) reduction of symptoms; and (4) improvement in QOL. Expansion to a larger randomized study is planned.
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Affiliation(s)
- Lindsey R. Mitrani
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Isaac Goldenthal
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Jamie Leskowitz
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Elaine Y. Wan
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Jose Dizon
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Deepak Saluja
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Ruth Masterson Creber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | | | - Robert R. Sciacca
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Judith Korner
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Angelo B. Biviano
- Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
- Address reprint requests and correspondence: Dr Angelo B. Biviano, Division of Cardiology, Department of Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY 10032.
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12
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MacGregor RM, Khiabani AJ, Bakir NH, Kelly MO, Perez SC, Maniar HS, Schuessler RB, Moon MR, Melby SJ, Damiano RJ. Impact of Obesity on Atrial Fibrillation Recurrence Following Stand-Alone Cox Maze IV Procedure. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:434-440. [PMID: 34180299 DOI: 10.1177/15569845211017176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Obesity is a strong and independent factor for the development of atrial fibrillation (AF), and adversely impacts the success of catheter ablation procedures for AF. This study evaluated the impact of body mass index (BMI) on the outcomes following surgical ablation of AF. METHODS Between 2003 and 2019, 236 patients underwent a stand-alone biatrial Cox maze IV procedure (CMP-IV) for refractory AF. Obesity was defined as BMI ≥30 kg/m2. Patients were divided into two groups: BMI <30 kg/m2 (n = 100) and BMI ≥30 kg/m2 (n = 136). Freedom from atrial tachyarrhythmia (ATA) was determined using electrocardiography, Holter, or pacemaker interrogation at 1 year and annually thereafter. Recurrence was defined as any documented ATA lasting ≥30 s. Predictors of recurrence were determined using multivariable logistic regression. Preoperative and procedural outcomes were compared between groups. RESULTS Obese patients had a higher rate of diabetes (16% vs 7%, P = 0.044) and larger left atrial diameter (4.9 ± 1.1 cm vs 4.6 ± 1.0 cm, P = 0.021) when compared to non-obese patients. There was no difference in major complication rate between the groups (4% vs 7%, P = 0.389). There was no operative mortality in either group. During 4.1 ± 2.4 years of follow-up, there was no significant difference in freedom from ATA with or without antiarrhythmic drugs in obese patients when compared to the non-obese group (P > 0.05). Absence of sinus rhythm at discharge predicted AF recurrence up to 7 years postoperatively. CONCLUSIONS As opposed to catheter ablation, obesity did not adversely impact the short and long-term outcomes of stand-alone surgical ablation with CMP-IV, and BMI was not a predictor of AF recurrence. Additionally, there was no significant increase in major complications in obese patients.
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Affiliation(s)
- Robert M MacGregor
- 122757548 Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Ali J Khiabani
- 122757548 Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Nadia H Bakir
- 122757548 Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Meghan O Kelly
- 122757548 Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Samuel C Perez
- 122757548 Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Hersh S Maniar
- 122757548 Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Richard B Schuessler
- 122757548 Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Marc R Moon
- 122757548 Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Spencer J Melby
- 122757548 Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Ralph J Damiano
- 122757548 Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
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Subjective assessment of complexity and prognosis after pulmonary vein isolation as significant predictor for procedural success. J Interv Card Electrophysiol 2021; 64:367-374. [PMID: 34089173 DOI: 10.1007/s10840-021-01005-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Subjective estimation of recurrence after atrial fibrillation ablation is an important tool in clinical use. The aim of this study is to evaluate (1) if the subjective complexity of an atrial fibrillation ablation procedure is correlated with rhythm stability and (2) if the subjective prognosis of the operator has a predictive value. METHODS We prospectively enrolled patients admitted for ablation of atrial fibrillation. Two scores were given immediately after the procedure by the operator: the complexity and the prognosis scores. With routine follow-ups, we tried to evaluate the correlation between the subjective scores and measured outcome. RESULTS The study population included 611 patients (63 ± 10 years, 37% females, 61% persistent AF). During follow-up (FU) (median 24, IQR 7-36 months), recurrences occurred in 44% patients. Both scores (prognosis and complexity) correlated significantly with age, persistent AF, LA diameter, procedural characteristics, and recurrences. On multivariable analysis, complexity (OR 1.304, 95%CI 1.016-1.675, p = 0.037) and prognosis (OR 1.443, 95%CI 1.080-1.982, p = 0.013) scores remained significant predictors for arrhythmia recurrences. On ROC analysis, both scores showed significant predictive value for rhythm outcomes after catheter ablation (AUC 0.599 and 0.613, both p < 0.001 for complexity and prognosis scores, respectively). CONCLUSIONS Complexity and prognosis scores are significant predictors for arrhythmia recurrences after AF catheter ablations and even independent when competing with simple risk factors.
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Pranata R, Henrina J, Yonas E, Putra ICS, Cahyadi I, Lim MA, Munawar DA, Munawar M. BMI and atrial fibrillation recurrence post catheter ablation: A dose-response meta-analysis. Eur J Clin Invest 2021; 51:e13499. [PMID: 33544873 DOI: 10.1111/eci.13499] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/03/2021] [Accepted: 01/14/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The evidence on the association between obesity and atrial fibrillation (AF) recurrence was equivocal. We aimed to evaluate the dose-response relationship between body mass index (BMI) and AF recurrence and adverse events. METHODS A systematic literature search was conducted using PubMed, Europe PMC, EBSCO, ProQuest and Cochrane Library. Obesity was defined as BMI ≥28 kg/m2 . The primary outcome was AF recurrence, and the secondary outcome was adverse events. Adverse events were defined as procedure-related complications and cardio-cerebrovascular events. RESULTS There were a total of 52,771 patients from 20 studies. Obesity was associated with higher AF recurrence (Odds ratio [OR] 1.30 [95% confidence interval [CI] 1.16-1.47], P < .001; I2 : 72.7%) and similar rate of adverse events (OR 1.21 [95% CI 0.87-1.67], P = .264; I2 : 23.9%). Meta-regression showed that the association varies by age (coefficient: -0.03, P = .024). Meta-analysis of highest versus lowest BMI showed that the highest group had higher AF recurrence (OR 1.37 [95% CI 1.18-1.58], P < .001; I2 : 64.9%) and adverse events (OR 2.02 [95% CI 1.08-3.76], P = .028; I2 : 49.5%). The linear association analysis for AF recurrence was not significant (P = .544). The dose-response relationship for BMI and AF recurrence was nonlinear (pnonlinearity < 0.001), the curve became steeper at 30-35 kg/m2 . For adverse events, an increase of 1% for every 1 kg/m2 increase in BMI (OR 1.01 [95% CI 1.00-1.02], P = .001), the relationship was nonlinear (pnonlinearity = 0.001). CONCLUSION Obesity was associated with higher AF recurrence in patients undergoing catheter ablation. High BMI might be associated with a higher risk for adverse events. PROSPERO ID CRD42020198787.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.,Binawaluya Cardiac Center, Jakarta, Indonesia
| | | | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | | | | | - Michael A Lim
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Dian A Munawar
- Department of Cardiology, Lyell McEwin Hospital, University of Adelaide, Elizabeth Vale, Australia.,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Munawar
- Binawaluya Cardiac Center, Jakarta, Indonesia.,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 5172] [Impact Index Per Article: 1724.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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17
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Impact of obesity on atrial fibrillation ablation. Arch Cardiovasc Dis 2020; 113:551-563. [PMID: 32753124 DOI: 10.1016/j.acvd.2020.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/07/2020] [Accepted: 03/11/2020] [Indexed: 11/23/2022]
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18
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Liu M, Mei K, Liu X, Zhao Y. Impact of body mass index on procedural complications, procedure duration, and radiation dose in patients with atrial fibrillation undergoing radiofrequency ablation: A systematic review and meta-analysis. Clin Cardiol 2020; 43:1067-1075. [PMID: 32492246 PMCID: PMC7534012 DOI: 10.1002/clc.23398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Abstract
Background The association of body mass index (BMI) and procedure‐related factors in patients with atrial fibrillation (AF) after radiofrequency ablation (RFA) is still unclear. Hypothesis BMI is associated with increased the radiation dose, procedure duration, and procedural complications. Methods Prospective studies assessing BMI and procedure duration, radiation dose, and procedural complications in patients with AF after RFA were identified through electronic searches of PubMed, Embase, and the Cochrane Library database. Results Ten studies with 14 735 participants undergoing RFA were included. Procedure duration was significantly longer in patients with overweight or obesity than in patients with normal BMI, with a mean difference (MD) of 0.95. Patients with overweight and obesity were exposed to a larger radiation dose, with standard MD of 1.71 and 1.98, respectively. There was no significant association between overweight or obesity and the risk of procedural complications (RR of 0.91 for overweight, 1.01 for obesity, 0.89 for stage I obesity, 1.00 for stage II obesity, and 0.94 for stage III obesity). Further analysis showed there was no significant difference regarding stroke or transient ischemic attack (overweight, RR: 0.92; obesity, RR: 1.02); cardiac tamponade (overweight, RR: 0.92; obesity, RR: 1.02); groin hematoma (overweight, RR: 0.62; obesity, RR: 0.40); or pulmonary vein stenosis (overweight, RR: 0.49; obesity, RR: 0.40) among BMI groups. Conclusion Based on available evidence, we first showed that patients with overweight/obesity undergoing RFA experienced a significantly increased procedure duration and received a larger radiation dose than patients with normal BMI; however, there was no significant difference in procedural complications between patients with overweight/obesity and patients with normal BMI.
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Affiliation(s)
- Menglu Liu
- Department of CardiologyThe Seventh People's HospitalZhengzhouHenanChina
| | - Kaibo Mei
- Department of AnesthesiologyThe People's Hospital of ShangraoJiangxiChina
| | - Xiao Liu
- Department of CardiologyThe Second Affiliated Hospital of Nanchang UniversityJiangxiChina
| | - Yujie Zhao
- Department of CardiologyThe Seventh People's HospitalZhengzhouHenanChina
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19
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Fujino T, Yuzawa H, Kinoshita T, Koike H, Shinohara M, Akitsu K, Yao S, Yano K, Suzuki T, Yamada M, Ikeda T. Clinical Factors Associated with a Successful Catheter Ablation Outcome in Elderly Patients with Atrial Fibrillation. Int Heart J 2020; 61:21-28. [PMID: 31956136 DOI: 10.1536/ihj.19-226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Catheter ablation is currently an established treatment for symptomatic paroxysmal atrial fibrillation (AF). We focused on elderly patients with a high prevalence of AF and attempted to identify the clinical factors associated with unsuccessful ablation outcomes.Among 735 consecutive patients who underwent AF ablation procedures, 108 (14.7%, 66 men) aged ≥ 75 years were included. Of them, 80 had paroxysmal AF, and the remaining 28 non-paroxysmal AF. All patients underwent pulmonary vein (PV) isolation and occasionally additional ablation. When AF recurred, redo ablation procedures were performed if the patient so desired.The mean number of ablation procedures was 1.1 ± 0.4 times per patient. During a mean follow-up of 38.7 ± 21.7 months, sinus rhythm was maintained in 100 patients (92.6%) without any antiarrhythmic drugs, but not in the remaining 8 (7.4%). Left atrial diameter (LAD, P < 0.001), left ventricular (LV) systolic diameter (P < 0.001), LV diastolic diameter (P = 0.001), non-PV AF foci (P = 0.036), and diabetes (P = 0.045) were associated with unsuccessful ablation procedures. Multivariate logistic regression analysis revealed a large LAD and non-PV AF foci were significant independent predictors of AF recurrences, with odds ratios of 0.76 (P = 0.019) and 0.04 (P = 0.023), respectively. In a total of 124 procedures, one major (0.8%) and 11 minor (8.9%) complications occurred.In elderly AF patients, catheter ablation of AF is effective and safe. Non-PV AF foci and a large LAD were independent clinical predictors of unsuccessful AF ablation outcomes.
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Affiliation(s)
- Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Hitomi Yuzawa
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Toshio Kinoshita
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Hideki Koike
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Masaya Shinohara
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Katsuya Akitsu
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Shintaro Yao
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Kensuke Yano
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Takeya Suzuki
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Midori Yamada
- Department of Adult Nursing, Toho University Faculty of Nursing
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
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20
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Providência R, Adragão P, de Asmundis C, Chun J, Chierchia G, Defaye P, Anselme F, Creta A, Lambiase PD, Schmidt B, Chen S, Cavaco D, Hunter RJ, Carmo J, Combes S, Honarbakhsh S, Combes N, Sousa MJ, Jebberi Z, Albenque J, Boveda S. Impact of Body Mass Index on the Outcomes of Catheter Ablation of Atrial Fibrillation: A European Observational Multicenter Study. J Am Heart Assoc 2019; 8:e012253. [PMID: 31581876 PMCID: PMC6818047 DOI: 10.1161/jaha.119.012253] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/12/2019] [Indexed: 12/26/2022]
Abstract
Background Outcomes of catheter ablation of atrial fibrillation (AF) are variable and the predictors of success require further elucidation since the identification of correctable risk factors could help to optimize therapy. We aimed to assess the impact of body mass index (BMI) in the overall safety and efficacy of catheter ablation of AF, with emphasis on the use of cryoballoon ablation and novel oral anticoagulants. Methods and Results There were 2497 consecutive patients undergoing catheter ablation of AF in 7 European high volume centers were stratified according to BMI (normal weight <25 kg/m2, pre-obese 25-30 kg/m2, obesity 30-35 kg/m2, and morbid obesity ≥35 kg/m2) and comparisons of procedural outcomes evaluated. Pre-obese and obese patients presented more comorbidities (hypertension, diabetes mellitus, and sleep apnea), and had higher rates of non-paroxysmal AF ablation procedures. The rate of atrial 12-month arrhythmia relapse increased alongside with BMI (35.2%, 35.7%, 43.6%, and 48.0% P<0.001). During a median follow-up of 18.8 months (interquartile range 11-28), after adjusting for all baseline differences, BMI was an independent predictor of relapse (hazard ratio=1.01 per kg/m2; 95% CI 1.01-1.02; P=0.002), adding incremental predictive value to obstructive sleep apnea. BMI was not a predictor for any of the reported complications. Using novel oral anticoagulants and cryoballoon ablation was safe and efficacy was comparable with vitamin-K antagonists and radiofrequency ablation. Conclusions Obese patients present with a more adverse comorbidity profile, more advanced forms of AF, and have lower chances of being free from AF relapse after ablation. Use of novel oral anticoagulants and cryoballoon ablation may be an option in this patient group.
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Affiliation(s)
- Rui Providência
- Clinic Pasteur of ToulouseToulouseFrance
- St. Bartholomew's HospitalBarts Health NHS TrustLondonUnited Kingdom
- Institute of Health Informatics ResearchUniversity College of LondonUnited Kingdom
| | - Pedro Adragão
- Cardiology DepartmentHospital de Santa CruzLisbonPortugal
| | - Carlo de Asmundis
- Heart Rhythm Management CentreUniversiteit Ziekenhuis BrusselBelgium
- Postgraduate program in Cardiac Electrophysiology and PacingVrije Universiteit BrusselBelgium
| | - Julian Chun
- Cardioangiologisches Centrum BethanienMedizinische Klinik III, Markus KrankenhausFrankfurt am MainGermany
| | - Gianbattista Chierchia
- Heart Rhythm Management CentreUniversiteit Ziekenhuis BrusselBelgium
- Postgraduate program in Cardiac Electrophysiology and PacingVrije Universiteit BrusselBelgium
| | | | | | - Antonio Creta
- St. Bartholomew's HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Pier D. Lambiase
- St. Bartholomew's HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Boris Schmidt
- Cardioangiologisches Centrum BethanienMedizinische Klinik III, Markus KrankenhausFrankfurt am MainGermany
| | - Shaojie Chen
- Cardioangiologisches Centrum BethanienMedizinische Klinik III, Markus KrankenhausFrankfurt am MainGermany
| | - Diogo Cavaco
- Cardiology DepartmentHospital de Santa CruzLisbonPortugal
| | - Ross J. Hunter
- St. Bartholomew's HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - João Carmo
- Cardiology DepartmentHospital de Santa CruzLisbonPortugal
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21
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Ammann EM, Kalsekar I, Yoo A, Scamuffa R, Hsiao CW, Stokes AC, Morton JM, Johnston SS. Assessment of obesity prevalence and validity of obesity diagnoses coded in claims data for selected surgical populations: A retrospective, observational study. Medicine (Baltimore) 2019; 98:e16438. [PMID: 31335698 PMCID: PMC6709187 DOI: 10.1097/md.0000000000016438] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
In many types of surgery, obesity may influence patient selection, prognosis, and/or management. Quantifying the accuracy of the coding of obesity and other prognostic factors is important for the design and interpretation of studies of surgical outcomes based on administrative healthcare data. This study assessed the validity of obesity diagnoses recorded in insurance claims data in selected surgical populations.This was a retrospective, observational study. Deidentified electronic health record (EHR) and linked administrative claims data were obtained for US patients age ≥20 years who underwent a qualifying surgical procedure (bariatric surgery, total knee arthroplasty [TKA], cardiac ablation, or hernia repair) in 2014Q1-2017Q1 (first = index). Patients' body mass index (BMI) as coded in the claims data (error-prone measure) during the index procedure or 180d pre-index was compared with their measured BMI as recorded in the EHR (criterion standard) to estimate the sensitivity and positive predictive value (PPV) of obesity diagnosis codes.Among patients who underwent bariatric surgery (N = 1422), TKA (N = 8670), cardiac ablation (N = 167), or hernia repair (N = 5450), obesity was present in 98%, 63%, 52%, and 54%, respectively, based on measured BMI. PPVs of obesity diagnosis codes were high: 99.3%, 96.0%, 92.8%, and 94.1% in bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively. The sensitivity of obesity diagnoses was: 99.8%, 46.2%, 41.3%, and 42.3% in bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively. Among false-positive patients diagnosed as obese but with measured BMI <30, the proportion with a BMI ≥28 was 40.0%, 67.6%, 60.7%, and 65.8% for bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively.Our data indicate that obesity is highly prevalent in many surgical populations, obesity diagnosis codes have high PPVs, but also obesity is generally undercoded in claims data. Quantifying the validity of diagnosis codes for obesity and other important prognostic factors is important for the design and interpretation of studies of surgical outcomes based on administrative data. Further research is needed to determine the extent to which undercoding of BMI and obesity can be addressed through the use of proxies that may be better documented in claims data.
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Affiliation(s)
- Eric M. Ammann
- Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ
| | | | - Andrew Yoo
- Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ
| | | | - Chia-Wen Hsiao
- Health Economics & Market Access, Ethicon, Cincinnati, OH
| | - Andrew C. Stokes
- Department of Global Health, School of Public Health, Boston University, Boston, MA
| | - John M. Morton
- Department of Surgery, Stanford University Medical Center, Stanford, CA
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22
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Bavishi AA, Kaplan RM, Peigh G, Diaz CL, Baman JR, Trivedi A, Wasserlauf J, Shen MJ, Sattayaprasert P, Chicos AB, Kim S, Verma N, Arora R, Lin A, Knight BP, Passman RS. Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:694-704. [PMID: 30912155 DOI: 10.1111/pace.13669] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/27/2019] [Accepted: 03/20/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND While several studies have evaluated predictors for atrial fibrillation (AF) recurrence following catheter ablation, there are limited data specific to cryoballoon ablation (CBA). METHODS We analyzed a prospective registry of patients at a single institution who underwent CBA. Recurrence of AF (RAF) was defined as recurrence of AF by 12-month follow-up, excluding the 3-month blanking period. Univariate analysis was performed to evaluate predictors of RAF. Receiver operating characteristic analysis was used to compare and evaluate the performance of various risk scores for discriminating risk of RAF. RESULTS There were 542 patients included in the analysis with mean age 61.3 ± 10.6 years, 67.9% male, and 51.6% paroxysmal AF (PAF). Overall, only left atrial diameter (LAD) > 40 mm and ERAF (early recurrence of AF within 0-3 month blanking period) were significant predictors of RAF. In the PAF specific subgroup, LAD > 40 mm, AF duration > 12 months, prior stroke or transient ischemic attack, ERAF, and having previously failed an antiarrhythmic drug were significant predictors of RAF. In persistent AF (PeAF) subgroup, obstructive sleep apnea (OSA) and ERAF were significant predictors of RAF. Out of clinical risk scores tested, BASEAF2 had the highest performance with area under the curve of 0.646 (95% confidence interval [0.548, 0.708]; P < .01). CONCLUSIONS In this single-center retrospective study of CBA, we found only LAD > 40 mm and ERAF to be predictors of RAF. We identified OSA as a potential targetable risk factor in PeAF patients undergoing CBA. Out of risk scores tested for discriminating risk of RAF, BASEAF2 had the best performance.
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Affiliation(s)
- Aakash A Bavishi
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rachel M Kaplan
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Graham Peigh
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Celso L Diaz
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jayson R Baman
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amar Trivedi
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jeremiah Wasserlauf
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Mark J Shen
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Prasongchai Sattayaprasert
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Alexandru B Chicos
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Susan Kim
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Nishant Verma
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Rishi Arora
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Albert Lin
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Bradley P Knight
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Rod S Passman
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
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23
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De Sensi F, Costantino S, Limbruno U, Paneni F. Atrial fibrillation in the cardiometabolic patient. Minerva Med 2019; 110:157-167. [DOI: 10.23736/s0026-4806.18.05882-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Homan EA, Reyes MV, Hickey KT, Morrow JP. Clinical Overview of Obesity and Diabetes Mellitus as Risk Factors for Atrial Fibrillation and Sudden Cardiac Death. Front Physiol 2019; 9:1847. [PMID: 30666210 PMCID: PMC6330323 DOI: 10.3389/fphys.2018.01847] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/07/2018] [Indexed: 12/22/2022] Open
Abstract
The epidemics of obesity and diabetes mellitus are associated with an increased incidence of both atrial fibrillation (AF), the most common sustained arrhythmia in adults, and sudden cardiac death (SCD). Obesity and DM are known to have adverse effects on cardiac structure and function. The pathologic mechanisms are thought to involve cardiac tissue remodeling, metabolic dysregulation, inflammation, and oxidative stress. Clinical data suggest that left atrial size, epicardial fat pad thickness, and other modifiable risk factors such as hypertension, glycemic control, and obstructive sleep apnea may mediate the association with AF. Data from human atrial tissue biopsies demonstrate alterations in atrial lipid content and evidence of mitochondrial dysfunction. With respect to ventricular arrhythmias, abnormalities such as long QT syndrome, frequent premature ventricular contractions, and left ventricular hypertrophy with diastolic dysfunction are commonly observed in obese and diabetic humans. The increased risk of SCD in this population may also be related to excessive cardiac lipid deposition and insulin resistance. While nutritional interventions have had limited success, perhaps due to poor long-term compliance, weight loss and improved cardiorespiratory fitness may reduce the frequency and severity of AF.
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Affiliation(s)
- Edwin A Homan
- Columbia University Medical Center, New York, NY, United States
| | - Michael V Reyes
- Columbia University Medical Center, New York, NY, United States
| | | | - John P Morrow
- Columbia University Medical Center, New York, NY, United States
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25
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Glover BM, Hong KL, Dagres N, Arbelo E, Laroche C, Riahi S, Bertini M, Mikhaylov EN, Galvin J, Kiliszek M, Pokushalov E, Kautzner J, Calvo N, Blomström-Lundqvist C, Brugada J. Impact of body mass index on the outcome of catheter ablation of atrial fibrillation. Heart 2018; 105:244-250. [DOI: 10.1136/heartjnl-2018-313490] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 11/04/2022] Open
Abstract
ObjectivesThe 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.MethodsBaseline, 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.ResultsAmong 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).ConclusionsPatients 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.
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26
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Congrete S, Bintvihok M, Thongprayoon C, Bathini T, Boonpheng B, Sharma K, Chokesuwattanaskul R, Srivali N, Tanawuttiwat T, Cheungpasitporn W. Effect of obstructive sleep apnea and its treatment of atrial fibrillation recurrence after radiofrequency catheter ablation: A meta-analysis. J Evid Based Med 2018; 11:145-151. [PMID: 30091301 DOI: 10.1111/jebm.12313] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 07/02/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVES Patients with obstructive sleep apnea (OSA) have an increased the risk of developing atrial fibrillation (AF). However, it remains unclear if patients with OSA carry a higher risk of recurrent AF after successful catheter ablation. This meta-analysis was conducted (1) to evaluate the association between OSA and recurrent AF after catheter ablation, and (2) to assess the effect of continuous positive airway pressure (CPAP) on the risk of recurrent AF in patients with OSA. METHODS A comprehensive literature review was conducted using MEDLINE, EMBASE, Cochrane databases from inception through July 2017 to identify studies that evaluated the risk of recurrent AF after successful catheter ablation in patients with OSA were included. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS Seven observational studies with a total of 4572 patients AF after successful catheter ablation were enrolled. Compared to patients without OSA, the pooled OR of recurrent AF in patients with OSA was 1.70 (95% CI, 1.40-2.06, I2 = 0). Among OSA patients with AF after successful catheter ablation, the use of CPAP was significantly associated with decreased risk of recurrent AF with pooled OR of 0.28 (0.19-0.40, I2 = 0). Egger's regression asymmetry test was performed and showed no publication bias for the associations of OSA and CPAP with recurrent AF. CONCLUSIONS Our meta-analysis suggested a significant association between OSA and recurrent AF after catheter ablation. The use of CPAP in patients with OSA is associated with reduced risk of recurrent AF after catheter ablation.
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Affiliation(s)
- Soontharee Congrete
- Department of Internal Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts
| | - Maythawee Bintvihok
- Department of Internal Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York
| | - Tarun Bathini
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York
| | - Boonphiphop Boonpheng
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Konika Sharma
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Narat Srivali
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, St. Agnes Hospital, Baltimore, Maryland
| | - Tanyanan Tanawuttiwat
- Division of Cardiology, Department of Medicine, University of Mississippi Medical Center, Mississippi
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Mississippi
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27
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Lee CJ, Kim TH, Park S, Pak HN. Obstructive Sleep Apnea Is Closely Related to Cardiovascular Risk Factors, but Not to Clinical Recurrence of Atrial Fibrillation after Catheter Ablation: An Analysis of Atrial Fibrillation Patients. Pulse (Basel) 2018; 6:103-111. [PMID: 30283752 DOI: 10.1159/000489854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 04/18/2018] [Indexed: 11/19/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is a well-known predictor of atrial fibrillation (AF). However, OSA usually accompanies other risk factors of AF. We tried to investigate whether OSA is related to AF recurrence after catheter ablation. Methods A total of 378 patients (mean age 59.9 ± 10.7 years, 72.5$ male) who underwent catheter ablation of AF were enrolled and underwent overnight ambulatory polysomnography before the ablation procedure. These patients were examined once every 3 months at the outpatient clinic to determine AF recurrence. Results Based on the apnea-hypopnea index (AHI), we divided the study subjects into 3 groups defined as mild (AHI < 10), moderate (10 <AHI < 30), or severe (AHI > 30) OSA. Patients with severe OSA had a higher prevalence of hypertension, diabetes mellitus, and coronary artery disease (CAD). However, AF recurrence was not different between the three groups. The Kaplan-Meier analysis also showed no significant difference in AF recurrence according to the degree of severity of OSA. Multivariate logistic regression analysis revealed that OSA might be a predictor of CAD; however, Cox regression analysis showed that only early recurrence is closely related to AF recurrence after catheter ablation, rather than the severity of OSA. Conclusion This study shows that the severity of OSA is not associated with the recurrence of AF after catheter ablation in Korean patients. Treatment of OSA for the sole indication of lowering AF recurrence may need to be reconsidered.
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Affiliation(s)
- Chan Joo Lee
- Department of Health Promotion, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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28
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Chen LY, Chung MK, Allen LA, Ezekowitz M, Furie KL, McCabe P, Noseworthy PA, Perez MV, Turakhia MP. Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e623-e644. [DOI: 10.1161/cir.0000000000000568] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Our understanding of the risk factors and complications of atrial fibrillation (AF) is based mostly on studies that have evaluated AF in a binary fashion (present or absent) and have not investigated AF burden. This scientific statement discusses the published literature and knowledge gaps related to methods of defining and measuring AF burden, the relationship of AF burden to cardiovascular and neurological outcomes, and the effect of lifestyle and risk factor modification on AF burden. Many studies examine outcomes by AF burden classified by AF type (paroxysmal versus nonparoxysmal); however, quantitatively, AF burden can be defined by longest duration, number of AF episodes during a monitoring period, and the proportion of time an individual is in AF during a monitoring period (expressed as a percentage). Current guidelines make identical recommendations for anticoagulation regardless of AF pattern or burden; however, a review of recent evidence suggests that higher AF burden is associated with higher risk of stroke. It is unclear whether the risk increases continuously or whether a threshold exists; if a threshold exists, it has not been defined. Higher burden of AF is also associated with higher prevalence and incidence of heart failure and higher risk of mortality, but not necessarily lower quality of life. A structured and comprehensive risk factor management program targeting risk factors, weight loss, and maintenance of a healthy weight appears to be effective in reducing AF burden. Despite this growing understanding of AF burden, research is needed into validation of definitions and measures of AF burden, determination of the threshold of AF burden that results in an increased risk of stroke that warrants anticoagulation, and discovery of the mechanisms underlying the weak temporal correlations of AF and stroke. Moreover, developments in monitoring technologies will likely change the landscape of long-term AF monitoring and could allow better definition of the significance of changes in AF burden over time.
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Desteghe L, Hendriks JML, McEvoy RD, Chai-Coetzer CL, Dendale P, Sanders P, Heidbuchel H, Linz D. The why, when and how to test for obstructive sleep apnea in patients with atrial fibrillation. Clin Res Cardiol 2018; 107:617-631. [DOI: 10.1007/s00392-018-1248-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/09/2018] [Indexed: 12/24/2022]
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30
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Sivasambu B, Balouch MA, Zghaib T, Bajwa RJ, Chrispin J, Berger RD, Ashikaga H, Nazarian S, Marine JE, Calkins H, Spragg DD. Increased rates of atrial fibrillation recurrence following pulmonary vein isolation in overweight and obese patients. J Cardiovasc Electrophysiol 2017; 29:239-245. [DOI: 10.1111/jce.13388] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/04/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Tarek Zghaib
- Johns Hopkins Hospital Heart and Vascular Institute; Baltimore MD USA
| | - Rizma J. Bajwa
- Johns Hopkins Hospital Heart and Vascular Institute; Baltimore MD USA
| | - Jonathan Chrispin
- Johns Hopkins Hospital Heart and Vascular Institute; Baltimore MD USA
| | - Ronald D. Berger
- Johns Hopkins Hospital Heart and Vascular Institute; Baltimore MD USA
| | - Hiroshi Ashikaga
- Johns Hopkins Hospital Heart and Vascular Institute; Baltimore MD USA
| | - Saman Nazarian
- Johns Hopkins Hospital Heart and Vascular Institute; Baltimore MD USA
- Division of Cardiology, Section for Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Joseph E. Marine
- Johns Hopkins Hospital Heart and Vascular Institute; Baltimore MD USA
| | - Hugh Calkins
- Johns Hopkins Hospital Heart and Vascular Institute; Baltimore MD USA
| | - David D. Spragg
- Johns Hopkins Hospital Heart and Vascular Institute; Baltimore MD USA
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31
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Phan K, Pison L, Wang N, Kanagaratnam A, Yan TD, Maesen B, Maessen JG, Crijns HJ, La Meir M. Effectiveness and safety of simultaneous hybrid thoracoscopic endocardial catheter ablation of atrial fibrillation in obese and non-obese patients. J Thorac Dis 2017; 9:3087-3096. [PMID: 29221283 DOI: 10.21037/jtd.2017.08.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We evaluated the safety and effectiveness of the hybrid thoracoscopic endocardial epicardial ablation technique for the treatment of atrial fibrillation (AF) in obese versus non-obese patients. Methods Between January 2010 and January 2015, a cohort of 61 patients were retrospectively identified to undergo ablation of AF as a stand-alone procedure using a thoracoscopic, hybrid epicardial-endocardial technique. All patients underwent continuous 7-day Holter monitoring at 3, 6 months, 1 year and yearly thereafter. Results A total of 40% of the obese cohort had persistent or long-standing AF, compared to 54.9% of the non-obese cohort. There were no deaths or conversion to cardiopulmonary bypass required. At 3-year follow-up, 60% of the obese group were in sinus rhythm (SR) with no episode of AF, atrial flutter or atrial tachycardia lasting 30 s off anti-arrhythmic drugs. This was compared to 70.6% in the non-obese group, with no significant difference between the groups (P=0.468). For success rates on anti-arrhythmic drugs, this was 80% in the obese group compared to 86% in the non-obese group at 3-year follow-up (P=0.637). No patient died and no thromboembolic/bleeding events or procedure-related complications occurred during the follow-up. Conclusions In a retrospective cohort with approximately half with persistent or long-standing AF, thoracoscopic hybrid epicardial endocardial ablation proved to be equally effective and safe in obese versus non-obese patients. Current preliminary findings require further validation in multi-institutional prospective studies with larger sample sizes.
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Affiliation(s)
- Kevin Phan
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Collaborative Research (CORE) Group, Macquarie Hospital, Sydney, Australia
| | - Laurent Pison
- Department of Cardiology, Maastricht University, Maastricht, the Netherlands
| | - Nelson Wang
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Aran Kanagaratnam
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Tristan D Yan
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Collaborative Research (CORE) Group, Macquarie Hospital, Sydney, Australia
| | - Bart Maesen
- Department of Cardiology, Maastricht University, Maastricht, the Netherlands
| | - Jos G Maessen
- Department of Cardiology, Maastricht University, Maastricht, the Netherlands
| | - Harry J Crijns
- Department of Cardiology, Maastricht University, Maastricht, the Netherlands
| | - Mark La Meir
- Department of Cardiology, Maastricht University, Maastricht, the Netherlands
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32
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Strotmann J, Fox H, Bitter T, Sauzet O, Horstkotte D, Oldenburg O. Characteristics of sleep-disordered breathing in patients with atrial fibrillation and preserved left ventricular ejection fraction. Clin Res Cardiol 2017; 107:120-129. [DOI: 10.1007/s00392-017-1163-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
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33
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Winkle RA, Mead RH, Engel G, Kong MH, Fleming W, Salcedo J, Patrawala RA. Impact of obesity on atrial fibrillation ablation: Patient characteristics, long-term outcomes, and complications. Heart Rhythm 2017; 14:819-827. [DOI: 10.1016/j.hrthm.2017.02.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Indexed: 10/20/2022]
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O'Neill L, Harrison J, O'Neill M, Williams SE. Clinical, electrophysiological and imaging predictors of atrial fibrillation ablation outcome. Expert Rev Cardiovasc Ther 2017; 15:289-305. [PMID: 28267401 DOI: 10.1080/14779072.2017.1303378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Significant technological advances for catheter ablation of atrial fibrillation (AF) have occurred over the last decade, with a consequent increase in numbers of patients referred for AF ablation worldwide. Despite this, long-term success rates, particularly in those with persistent AF, remain modest. The patient population presenting for AF ablation are heterogeneous with regard to age, type of AF and presence of associated cardiovascular disease. Improved understanding of factors predicting response to AF ablation may therefore help to improve patient selection for ablation procedures. Areas covered: This review outlines the clinical, electrophysiological and imaging predictors of response to radiofrequency ablation for AF in contemporary practice. Recently developed scoring systems incorporating these parameters are examined, as are factors identified thus far which may predict the outcome of cryoballoon ablation. Expert commentary: Traditional clinical factors associated with ablation outcomes serve as surrogates rather than direct measures of the underlying arrhythmia substrate. An improved understanding of this substrate could improve the prediction of response to radiofrequency ablation. Continued development of methods for characterising the arrhythmia substrate, including atrial cardiac magnetic resonance imaging and invasive voltage mapping, may inform patient risk assessment and help guide selection for catheter ablation on an increasingly individualistic basis.
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Affiliation(s)
- Louisa O'Neill
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - James Harrison
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - Mark O'Neill
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
| | - Steven E Williams
- a Division of Imaging Sciences and Biomedical Imaging , King's College London , London , United Kingdom
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35
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MATSUMOTO HIROKI, KASAI TAKATOSHI. Cardiovascular Disease and Sleep. JUNTENDO MEDICAL JOURNAL 2017. [DOI: 10.14789/jmj.63.435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- HIROKI MATSUMOTO
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine
- Department of Cardiovascular Medicine, Juntendo University Faculty of Medicine
| | - TAKATOSHI KASAI
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine
- Department of Cardiovascular Medicine, Juntendo University Faculty of Medicine
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PRABHU SANDEEP, MACKIN VINCENT, MCLELLAN ALEXJ, PHAN TUONG, MCGLADE DESMOND, LING LIANGHAN, PECK KAHY, VOSKOBOINIK ALEXANDR, PATHIK BUPESH, NALLIAH CHRISHANJ, WONG GEOFFR, AZZOPARDI SONIAM, LEE GEOFFREY, MARIANI JUSTIN, TAYLOR ANDREWJ, KALMAN JONATHANM, KISTLER PETERM. Determining the Optimal Dose of Adenosine for Unmasking Dormant Pulmonary Vein Conduction Following Atrial Fibrillation Ablation: Electrophysiological and Hemodynamic Assessment. DORMANT-AF Study. J Cardiovasc Electrophysiol 2016; 28:13-22. [DOI: 10.1111/jce.13107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- SANDEEP PRABHU
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | | | - ALEX J.A. MCLELLAN
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | - TUONG PHAN
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | | | - LIANG-HAN LING
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | - KAH Y. PECK
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
| | - ALEXANDR VOSKOBOINIK
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | - BUPESH PATHIK
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - CHRISHAN J. NALLIAH
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - GEOFF R. WONG
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - SONIA M. AZZOPARDI
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
| | - GEOFFREY LEE
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - JUSTIN MARIANI
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
| | - ANDREW J. TAYLOR
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | - JONATHAN M. KALMAN
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - PETER M. KISTLER
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
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Tscholl V, Lsharaf AKA, Lin T, Bellmann B, Biewener S, Nagel P, Suhail S, Lenz K, Landmesser U, Roser M, Rillig A. Two years outcome in patients with persistent atrial fibrillation after pulmonary vein isolation using the second-generation 28-mm cryoballoon. Heart Rhythm 2016; 13:1817-22. [DOI: 10.1016/j.hrthm.2016.05.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Indexed: 11/27/2022]
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38
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Clinical significance of nutritional status in patients with atrial fibrillation: An overview of current evidence. J Cardiol 2016; 69:719-730. [PMID: 27520756 DOI: 10.1016/j.jjcc.2016.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/26/2016] [Accepted: 06/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity is a well-known atherosclerosis risk factor; however, its role and the importance of undernutrition in atrial fibrillation (AF) pathogenesis are still not well understood. The aim of this study was to present the current state of knowledge on this issue in different groups of patients. METHODS Systematic review of papers published between 1980 and 2016. RESULTS The literature shows contradicting views regarding the impact of nutritional status on the risk, course, and complications of AF. On the one hand, it has been revealed that overweight, obesity, and high birth mass increase the risk of AF, and that their reduction is linked to an improved course of AF and reduced all-cause and cardiovascular mortality. On the other hand, a so-called obesity paradox has been found, which shows lower all-cause mortality in overweight patients with AF compared to those of normal weight or who are underweight. It has also been shown, although based on a small number of studies, that the relationship between nutritional status and risk of AF and its complication may be U-shaped, which means that not only patients with obesity, but also individuals with underweight, cachexia, and low birth weight may have an increased risk and poor outcome of AF. CONCLUSIONS The relationship between patients' nutritional status and the course of AF has become clearer but it requires further studies examining the importance of weight reduction on AF course.
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39
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Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on Atrial cardiomyopathies: Definition, characterisation, and clinical implication. J Arrhythm 2016; 32:247-78. [PMID: 27588148 PMCID: PMC4996910 DOI: 10.1016/j.joa.2016.05.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hô pitaux de Paris, Pitié-Salpêtrière Hospital, Sorbonne University, INSERM UMR_S1166, Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundació n and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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40
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Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace 2016; 18:1455-1490. [PMID: 27402624 DOI: 10.1093/europace/euw161] [Citation(s) in RCA: 429] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Sorbonne University; INSERM UMR_S1166; Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundación and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada .,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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41
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EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Heart Rhythm 2016; 14:e3-e40. [PMID: 27320515 DOI: 10.1016/j.hrthm.2016.05.028] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 12/21/2022]
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42
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Nalliah CJ, Sanders P, Kalman JM. Obstructive Sleep Apnea Treatment and Atrial Fibrillation: A Need for Definitive Evidence. J Cardiovasc Electrophysiol 2016; 27:1001-10. [PMID: 27060686 DOI: 10.1111/jce.12981] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/20/2016] [Accepted: 03/29/2016] [Indexed: 11/29/2022]
Abstract
Prevalence rates of atrial fibrillation (AF) and obstructive sleep apnea (OSA) are rising on a global scale. Epidemiological data have consistently demonstrated an independent association between the 2 conditions. Investigators pose that pathophysiologic features of OSA enable progression of the AF substrate; these features include abnormalities of gas exchange, autonomic remodeling, atrial stretch, and inflammation. Furthermore, many of the mechanistic perturbations that impact the AF substrate in OSA can be substantially attenuated by effective treatment with continuous positive airway pressure (CPAP). Clear associations of OSA treatment and improved AF control have been observed across multiple clinical contexts. However, the precision and generalizability of these findings are unclear in view of the data's observational nature. Although risk factor management has emerged as a critical component of AF treatment, effective control of many AF risk factors can be challenging in the longer term. In view of the efficacy and sustainability of CPAP therapy, OSA raises its profile as a prime candidate for intervention. However, translation of this strategy to the broader framework for AF management requires robust data from randomized controlled trials.
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Affiliation(s)
- Chrishan J Nalliah
- Department of Cardiology, Royal Melbourne Hospital and the Department of Medicine, University of Melbourne, Melbourne, Australia.,Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital and the Department of Medicine, University of Melbourne, Melbourne, Australia
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43
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Bunch TJ, May HT, Bair TL, Crandall BG, Cutler MJ, Jacobs V, Mallender C, Muhlestein JB, Osborn JS, Weiss JP, Day JD. Long-term influence of body mass index on cardiovascular events after atrial fibrillation ablation. J Interv Card Electrophysiol 2016; 46:259-65. [DOI: 10.1007/s10840-016-0142-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/27/2016] [Indexed: 02/02/2023]
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44
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Lin KJ, Schneeweiss S. Considerations for the analysis of longitudinal electronic health records linked to claims data to study the effectiveness and safety of drugs. Clin Pharmacol Ther 2016; 100:147-59. [DOI: 10.1002/cpt.359] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/18/2016] [Indexed: 12/18/2022]
Affiliation(s)
- KJ Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts USA
- Department of Medicine, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts USA
- Department of Epidemiology; Harvard School of Public Health; Boston Massachusetts USA
| | - S Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts USA
- Department of Epidemiology; Harvard School of Public Health; Boston Massachusetts USA
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45
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Habibi M, Lima JA, Gucuk Ipek E, Zimmerman SL, Zipunnikov V, Spragg D, Ashikaga H, Rickard J, Marine JE, Berger RD, Calkins H, Nazarian S. The association of baseline left atrial structure and function measured with cardiac magnetic resonance and pulmonary vein isolation outcome in patients with drug-refractory atrial fibrillation. Heart Rhythm 2016; 13:1037-1044. [DOI: 10.1016/j.hrthm.2016.01.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Indexed: 12/12/2022]
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46
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Zhu X, Li Q, Li Y, Wu Z. Analysis of Bipolar Radiofrequency Ablation in Treatment of Atrial Fibrillation Associated with Rheumatic Heart Disease. PLoS One 2016; 11:e0151248. [PMID: 26960188 PMCID: PMC4784895 DOI: 10.1371/journal.pone.0151248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/20/2016] [Indexed: 02/05/2023] Open
Abstract
Background Among patients with rheumatic heart disease (RHD), 45% to 60% present with atrial fibrillation (AF), which is associated with increased rates of thromboembolism, heart failure, and even death. The bipolar radiofrequency ablation (BRFA) combining with mitral valve procedure has been adopted in patients of AF associated with RHD, but evaluations about its effectiveness are still limited. Methods A total of 87 patients with RHD and long persistent AF who had accepted mitral valve replacement concomitant with BRFA were studied. Clinical data were collected to analyze the midterm results of BRFA and evaluate its efficiency. Univariate and multivariate analyses were used to identify the independent factors associated with late AF recurrence. Results Sixty-six (75.9%) patients maintained sinus rhythm after a mean follow-up of 13.4 ± 5.2 months. Late AF recurrence had been detected in 21 (24.1%) patients, 11 (12.6%) patients were confirmed to be AF, 8 (9.2%) patients were atrial flutter and 2 (2.3%) patients were junctional rhythm. In Multivariate logistic regression analysis, body mass index (BMI) (OR = 1.756, 95% CI = 1.289–2.391, p = 0.000) and early AF recurrence (OR = 5.479, 95% CI = 1.189–25.254, p = 0.029) were independent predictors of late AF recurrence. In addition, left ventricular ejection fraction (LVEF) and New York Heart Association class showed a greater improvement in patients who maintained sinus rhythm than those who experienced late AF recurrence. Conclusion BRFA is an effective technique for the treatment of long persistent AF associated with RHD during mitral valve replacement. The BMI and early AF recurrence are independent predictors for late AF recurrence. Patients with long-term restoration of sinus rhythm experienced a greater improvement of left ventricular function after BRFA.
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Affiliation(s)
- Xiliang Zhu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Qian Li
- West China School of Medicine, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Yang Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
- * E-mail:
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Biatrial linear ablation in sustained nonpermanent AF: Results of the substrate modification with ablation and antiarrhythmic drugs in nonpermanent atrial fibrillation (SMAN-PAF) trial. Heart Rhythm 2016; 13:399-406. [DOI: 10.1016/j.hrthm.2015.10.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Indexed: 11/20/2022]
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48
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Lee GK, Cha YM. Cardiovascular benefits of bariatric surgery. Trends Cardiovasc Med 2015; 26:280-9. [PMID: 26776254 DOI: 10.1016/j.tcm.2015.07.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/15/2015] [Accepted: 07/21/2015] [Indexed: 01/02/2023]
Abstract
The prevalence of obesity is increasing in the United States and worldwide, bringing with it an excess of morbidity and premature death. Obesity is strongly associated with both traditional cardiovascular risk factors as well as direct effects on hemodynamics and cardiovascular structure and function. In fact, cardiovascular disease is one of the major causes of morbidity and mortality in obese patients. Often, lifestyle and pharmacological weight-loss interventions are of limited efficacy in severely obese patients. Bariatric surgery has been shown to be a feasible option to achieve substantial and sustained weight loss in this group of patients. It is a safe procedure with low in-hospital and 30-day mortality rates even in groups that are considered higher risk for surgery (e.g., the elderly), especially if performed in high-volume centers. There is observational evidence that bariatric surgery in severely obese patients is associated with both a reduction of traditional cardiovascular risk factors as well as improvement in cardiac structure and function. Marked decreases in the levels of inflammatory and prothrombotic markers, as well as markers of subclinical atherosclerosis and endothelial dysfunction, are seen after bariatric surgery. This article summarizes the existing evidence regarding the cardiovascular benefits in patients following bariatric surgery.
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Affiliation(s)
- Glenn K Lee
- Department of Medicine, National University Health System, Singapore
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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Shoemaker MB, Gidfar S, Pipilas DC, Tamboli RA, Savio Galimberti E, Williams DB, Clements RH, Darbar D. Prevalence and predictors of atrial fibrillation among patients undergoing bariatric surgery. Obes Surg 2015; 24:611-6. [PMID: 24214203 DOI: 10.1007/s11695-013-1123-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND While AF is a disease of the elderly, it can occur earlier in the presence of risk factors such as obesity. Bariatric surgery patients are significantly younger and more obese than previously described populations with AF. Therefore, it remains to be determined whether current estimates of the prevalence and predictors for AF remain true in the bariatric surgery population. METHODS We performed a cross-sectional analysis of 1,341 consecutive patients who underwent bariatric surgery from January 2008 to October 2012. Baseline characteristics were compared between patients with and without AF. For additional comparison, 176 patients with AF and body mass index (BMI) >40 kg/m(2) were identified from the Vanderbilt AF Registry. A multivariable logistic regression was performed to identify predictors of AF within the bariatric surgery cohort. RESULTS The prevalence of AF in the bariatric surgery cohort was 1.9 % (25/1,341). Patients with AF were older (median 56 years (interquartile range [52-64) vs.46 [38-56] years, p < 0.001), were more often male (48 vs. 23 %, p = 0.004), had more comorbidities, but had no difference in BMI (50 kg/m(2) [44-58] vs. 48 [43-54], p = 0.4). In multivariable analysis, the odds of AF increased 2.2-fold by age per decade (95 % CI, 1.4-3.5; p < 0.001) and 2.4-fold by male gender (1.1-5.4, p = 0.03) when adjusted for BMI. BMI was not independently associated with AF (OR 1.15 [95 % CI, 0.98-1.41], p = 0.09). CONCLUSIONS The prevalence of AF is 1.9 % among patients undergoing bariatric surgery. Risk of AF was found to increase with age and male gender, but not with higher BMI.
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Affiliation(s)
- M Benjamin Shoemaker
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA,
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50
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Wang HJ, Si QJ, Shan ZL, Guo YT, Lin K, Zhao XN, Wang YT. Effects of body mass index on risks for ischemic stroke, thromboembolism, and mortality in Chinese atrial fibrillation patients: a single-center experience. PLoS One 2015; 10:e0123516. [PMID: 25848965 PMCID: PMC4388788 DOI: 10.1371/journal.pone.0123516] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/19/2015] [Indexed: 01/24/2023] Open
Abstract
Background Obesity is considered to be related to recurrence of atrial fibrillation (AF), left atrial thrombus formation, and atrial remodeling. However, whether obesity is an independent risk factor for stroke and other thromboembolic events is still controversial. Objective This study aimed to investigate the effects of body mass index (BMI) on the risks of stroke, thromboembolism, and mortality in AF patients. Methods Patients who were diagnosed with nonvalvular AF were included in this observational, retrospective study. The study population was stratified by BMI at baseline. The Cox proportional hazard model was adopted to calculate adjusted hazard ratios of risk factors for adverse clinical events (stroke, thromboembolism, and mortality). Results A total of 1286 AF patients (males, 78.30%; mean age, 74.50 years; 94.48% paroxysmal AF) were followed up for a median of 2.1 years (IQR: 1.5–2.9 years). Overall, 159 patients died. A total of 84 strokes and 35 thromboembolic events occurred. Multivariate analysis showed that overweight (25.0≤BMI<30.0 kg/m2) and age ≥75 years were independent risk factors for ischemic stroke (both P<0.01). Obesity (BMI ≥30.0 kg/m2), age ≥75 years, persistent/permanent AF, and prior thromboembolism were independent risk factors for thromboembolism (all P<0.05). Underweight (BMI <18.5 kg/m2), age ≥75 years, prior ischemic stroke/transient ischemic attack, renal dysfunction, and heart failure were independent risk factors for all-cause deaths (all P<0.05). Conclusions Overweight or obesity may be a risk factor of ischemic stroke and thromboembolism in AF patients. Excessive low weight is significantly associated with increased all-cause mortality.
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Affiliation(s)
- Hai-Jun Wang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Quan-Jin Si
- Healthcare Department 2, Hainan Branch of Chinese PLA General Hospital, Sanya, China
- * E-mail: (YTW); (QJS)
| | - Zhao-Liang Shan
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yu-Tao Guo
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Kun Lin
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Ning Zhao
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yu-Tang Wang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
- * E-mail: (YTW); (QJS)
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