Abstract 15459: Impact of Progression From Paroxysmal to Sustained Atrial Fibrillation on Clinical Outcomes in Patients With Obesity: The Fushimi Af Registry

Abstract

Background: Obesity, which leads to left arterial remodeling, increases the risk for the development of atrial fibrillation (AF). We previously demonstrated the progression from paroxysmal to sustained AF was associated with an increased risk of ischemic stroke or hospitalization for heart failure (HF). However, the risk of progression from paroxysmal to sustained AF in obese patients has not been fully evaluated. Methods: Based on the initial type of AF and whether paroxysmal AF progressed to sustained AF during follow-up (FU), patients enrolled in the Fushimi AF registry were categorized into 3 groups; i) paroxysmal AF without progression, ii) paroxysmal AF with progression, iii) sustained AF. Obesity was defined as BMI at baseline >30. Results: Obese patients (172/3834) had a higher prevalence of sustained AF at baseline as compared with those without obesity (58.7% vs 51.0%, p=0.047), and they had a higher rate of progression from paroxysmal to sustained AF during a median FU of 4.3 years (2.4% vs 1.5% [per person-year], p<0.01). Both obese and non-obese patients had the highest rate of ischemic stroke in the category of paroxysmal AF with progression as compared with other two categories (obese patients: 0.2% [paroxysmal AF without progression] vs 2.6% [paroxysmal AF with progression] vs 0.7% [sustained AF] [per person-year], non-obese patients: 1.2% vs 2.2% vs 1.8%). In contrast, obese patients had the lowest percentage of hospitalization for HF in the category of paroxysmal AF with progression (2.5% vs 1.8% vs 3.8%), but AF progression was associated with a higher incidence of hospitalization for HF in patients without obesity (2.2% vs 3.9% vs 4.2%). Conclusions: Obesity may be the risk of the progression of paroxysmal to sustained AF. The progression may be associated with increased risk of ischemic stroke in both obese and non-obese patients, but the risk of hospitalization for HF might be lower in patients with obesity as compared with those without obesity.