Recurrence rates higher, but should it wait for weight loss?
Obese patients getting catheter ablation may be especially likely to have atrial fibrillation (Afib) recur within the year, a study suggested.
Afib recurrence was reported for 37.7% of those who got the procedure while having a body mass index (BMI) of 30.0 or higher versus 32.3% of normal-weight peers (HR 1.223, 95% CI 1.047-1.429), according to data from the ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry.
Individuals who were overweight at the time of catheter ablation did not suffer more recurrence, on the other hand (32.4% versus 32.3%, HR 0.954, 95% CI 0.798-1.140), reported a group of researchers led by Benedict Glover, MD, of Queen's University in Kingston, Ontario. Their study was published online in Heart
Because their propensity-weighted analysis supported similar prior findings of reduced efficacy of catheter ablation at high BMIs, the investigators suggested lifestyle modification to target obesity before the procedure.
While Glover's study was the largest study so far looking at this population and confirmed poorer outcomes related to disease progression and treatment in obesity, Nassir Marrouche, MD, of the University of Utah School of Medicine in Salt Lake City, expressed skepticism about holding off on ablation until patients lose weight.
"This is the dilemma facing the physician performing the Afib ablation procedure. We usually see Afib patients that are referred for ablation. Those patients usually go through various non-invasive treatment options and are highly symptomatic before they see us," he commented in an interview with MedPage Today.
"We tend to discuss life style modification and losing weight options/treatment with them, but success has been disappointing. It is hard to send a symptomatic Afib patients back home with no treatment and tell them to 'just lose weight,'" said Marrouche, who was not involved in the study.
There needs to be better coordination among electrophysiology, preventive medicine, and sleep apnea clinics for the management of these patients, he said.
Glover's group studied 3,333 consecutive patients getting catheter ablation for Afib in 2012-2015.
Overweight and obese individuals made up 46.1% and 32.0% of the group, respectively. These patients had a higher comorbidity burden at baseline. They had longer procedure times and received more radiation but were no more likely than patients with a normal BMI to have periprocedural complications.
Procedures were performed at 104 participating centers in 27 countries; only medium- or high-experience centers had been invited for voluntary participation, which may limit the study's generalizability.
Other independent predictors of Afib recurrence included the type of Afib and postoperative antiarrhythmic medication use.
Glover reported no conflicts of interest.
Study co-authors disclosed ties to Biosense Webster, Boehringer Inhelheim, Medtronic, Johnson & Johnson, Abbott, Biotronik, and Boston Scientific.
Source Reference: Glover BM, et al "Impact of body mass index on the outcome of catheter ablation of atrial fibrillation" Heart 2018; DOI: 10.1136/heartjnl-2018-313490.
Read the original article on Medpage Today: Afib Catheter Ablation Less Effective for Obese Patients