title: A prospective study evaluating the role of obesity and obstructive sleep apnea for outcomes after catheter ablation of atrial fibrillation.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Karuna
authors.initials: K
authors.lastname: Chilukuri
authors.forename: Darshan
authors.initials: D
authors.lastname: Dalal
authors.forename: Shrirang
authors.initials: S
authors.lastname: Gadrey
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
authors.forename: Edwin
authors.initials: E
authors.lastname: Macpherson
authors.forename: Charles A
authors.initials: CA
authors.lastname: Henrikson
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
authors.forename: Sunil
authors.initials: S
authors.lastname: Sinha
authors.forename: David
authors.initials: D
authors.lastname: Spragg
authors.forename: Ronald
authors.initials: R
authors.lastname: Berger
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
mesh_terms: 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