title: Relation of morbid obesity and female gender to risk of procedural complications in patients undergoing atrial fibrillation ablation.
abstract: Obese patients with atrial fibrillation (AF) are frequently treated with AF ablation. We sought to examine whether a body mass index (BMI) threshold exists beyond which the odds of experiencing a complication from AF ablation increases. All patients enrolled in the Vanderbilt AF Registry who underwent catheter-based AF ablation from May 1999 to February 2012 were included. Major complications were recorded. Morbid obesity was defined as a BMI >40 kg/m(2) and examined in multivariable analysis. A total of 35 complications (6.8%) occurred in 512 ablations. Morbidly obese patients experienced a greater rate of complications (6 of 42, 14.3%) than the nonmorbidly obese (29 of 470, 6.2%; p = 0.046). Using a discrete BMI cutoff, the odds of complications increased 3.1-fold in those with morbid obesity (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.1 to 8.4, p = 0.03) and 2.1-fold for female gender (OR 2.1, 95% CI 1.04 to 4.38, p = 0.04). With BMI as a continuous variable, the odds of complications increased by 5% per 1 unit increase in BMI (OR 1.05, 95% CI 1.0 to 1.11, p = 0.05), and the increase for female gender was 2.2-fold (OR 2.2, 95% CI 1.1 to 4.6, p = 0.03). In conclusion, morbid obesity represents a BMI threshold above which the odds of complications with AF ablation increase significantly. The increase in complications appears to be driven primarily by events in women, suggesting that morbidly obese women are a special population when considering AF ablation.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: M Benjamin
authors.initials: MB
authors.lastname: Shoemaker
authors.forename: Raafia
authors.initials: R
authors.lastname: Muhammad
authors.forename: Maureen
authors.initials: M
authors.lastname: Farrell
authors.forename: Babar
authors.initials: B
authors.lastname: Parvez
authors.forename: Brenda W
authors.initials: BW
authors.lastname: White
authors.forename: Megan
authors.initials: M
authors.lastname: Streur
authors.forename: Tanya
authors.initials: T
authors.lastname: Stubblefield
authors.forename: Jason
authors.initials: J
authors.lastname: Rytlewski
authors.forename: Sunthosh
authors.initials: S
authors.lastname: Parvathaneni
authors.forename: Rangadham
authors.initials: R
authors.lastname: Nagarakanti
authors.forename: Dan M
authors.initials: DM
authors.lastname: Roden
authors.forename: Pablo
authors.initials: P
authors.lastname: Saavedra
authors.forename: Christopher
authors.initials: C
authors.lastname: Ellis
authors.forename: S Patrick
authors.initials: SP
authors.lastname: Whalen
authors.forename: Dawood
authors.initials: D
authors.lastname: Darbar
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D015992:Body Mass Index; D017115:Catheter Ablation / Q000009:adverse effects*; D016001:Confidence Intervals; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013714:Tennessee / Q000453:epidemiology; D016896:Treatment Outcome