A prospective study evaluating the role of obesity and obstructive sleep apnea for outcomes after catheter ablation of atrial fibrillation.
BACKGROUND
Obesity and obstructive sleep apnea (OSA) have a strong association with atrial fibrillation (AF). The purpose of this study was to prospectively determine the effects of obesity, assessed by the body mass index (BMI) and OSA on the efficacy of catheter ablation of AF.


METHODS
The patient population consisted of 109 patients (mean age: 60 +/- 10 years, 79% male, 67% paroxysmal, mean BMI 28 +/- 5 kg/m(2)) who underwent catheter ablation of AF. Based on BMI, patients were classified as normal (<25 kg/m(2)), overweight (>or=25 and <30 kg/m(2)), or obese (>or=30 kg/m(2)). OSA was assessed by the Berlin questionnaire. Clinical success was defined as at least 90% reduction in AF burden after 3-month blanking period. Mean duration of follow-up was 11 +/- 4 months.


RESULTS
Of the 75 patients with clinical success, 25 (33%) had normal BMI, 29 (39%) were overweight, and 21 (28%) were obese. Among the 34 patients with failed outcome, 5 (15%) had normal BMI, 14 (41%) were overweight, and 15 (44%) were obese (P = 0.04). Twenty-eight of the 48 patients with OSA (58%) had clinical success as opposed to 47 of the 61 patients (77%) without OSA (P = 0.036). On multivariate analysis, only BMI emerged as an independent predictor of procedural failure ((OR 1.11, CI: 1.00-1.21, P = 0.03).


CONCLUSIONS
The results of this prospective study show that obesity, a modifiable risk factor, is an independent predictor of procedural failure after catheter ablation of AF. Whether treating obesity may improve the results of catheter ablation of AF warrants further investigation.
Chilukuri
Karuna
K
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Dalal
Darshan
D
Gadrey
Shrirang
S
Marine
Joseph E
JE
Macpherson
Edwin
E
Henrikson
Charles A
CA
Cheng
Alan
A
Nazarian
Saman
S
Sinha
Sunil
S
Spragg
David
D
Berger
Ronald
R
Calkins
Hugh
H
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery*; D015992:Body Mass Index; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011446:Prospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications*; D017211:Treatment Failure; D016896:Treatment Outcome