Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation.
BACKGROUND
Obesity and obstructive sleep apnea (OSA) are associated with atrial fibrillation (AF). The effects of a large body mass index (BMI) and OSA on the results of radiofrequency catheter ablation (RFA) of AF are unclear.


OBJECTIVE
To evaluate the effect of BMI and OSA on the efficacy of RFA for AF.


METHODS
RFA was performed in 324 consecutive patients (mean age = 57 +/- 11 years) with paroxysmal (234) or chronic (90) AF. OSA was diagnosed by polysomnography in 32 of 324 patients (10%) prior to ablation. Among the 324 patients, 18% had a normal BMI (<25 kg/m(2)), 39% were overweight (BMI >/= 25 kg/m(2) and <30 kg/m(2)), and 43% were obese (>or=30 kg/m(2)). RFA was performed to eliminate complex fractionated atrial electrograms (CFAE) in the pulmonary vein antrum and left atrium.


RESULTS
At 7 +/- 4 months after a single ablation procedure, 63% of patients without OSA and 41% with OSA were free from recurrent AF without antiarrhythmic drug therapy (P = 0.02). Multivariate analysis including variables of age, gender, type and duration of AF, OSA, BMI, left atrial size, ejection fraction, and hypertension demonstrated that OSA was the strongest predictor of recurrent AF (OR = 3.04, 95% CI: 1.11-8.32, P = 0.03). There was no association between BMI and freedom from recurrent AF. A serious complication occurred in 3 of 324 patients, with no relationship to BMI.


CONCLUSIONS
OSA is a predictor of recurrent AF after RFA independent of its association with BMI and left atrial size. Obesity does not appear to affect outcomes after radiofrequency catheter ablation of AF.
Jongnarangsin
Krit
K
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA. kritj@umich.edu
Chugh
Aman
A
Good
Eric
E
Mukerji
Siddharth
S
Dey
Sujoya
S
Crawford
Thomas
T
Sarrazin
Jean F
JF
Kuhne
Michael
M
Chalfoun
Nagib
N
Wells
Darryl
D
Boonyapisit
Warangkna
W
Pelosi
Frank
F
Bogun
Frank
F
Morady
Fred
F
Oral
Hakan
H
D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D015992:Body Mass Index; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000601:surgery; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000517:prevention & control; D016896:Treatment Outcome