Long-term cardiovascular outcomes of patients with extreme obesity following atrial fibrillation ablation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Obesity and extreme obesity increase risk of recurrent atrial fibrillation (AF) and perioperative complications following AF ablation. However, long-term outcomes following AF ablation among obese patients is unknown. Purpose To examine long-term cardiovascular (CV) mortality and hospitalization among obese patients undergoing AF ablation Methods This retrospective study included 830 consecutive patients undergoing AF ablation from January 2013 to June 2019 at a tertiary referral medical center. Patients with obesity defined as body mass index (BMI) ≥30-39.9 kg/m2 and a subgroup of patients with extreme obesity with BMI ≥40 kg/m2 were identified. Patients were monitored for mortality and hospitalization during a median follow-up time of 819 days. Multivariate model adjusting for CHA2DS2-VASc score and history of obstructive sleep apnea (OSA) was performed. Results Mean age was 62 ± 10 years and 67.5% were male. Obese patients (n = 493, 59%) had a higher CHA2DS2-VASc score, and greater prevalence of OSA. These patients tended to have higher all-cause mortality and hospitalization (adjusted HR, 1.21 95% CI 0.98 to 1.51; P = 0.078), as well as greater non-CV outcomes (adjusted HR 1.45, 95% CI 1.02 to 2.08; P = 0.04). However, CV death and admission were comparable among patients with and without obesity (adjusted HR 1.14, 95% CI 0.90 to 1.45; P = 0.28). A subgroup of 111 (13.4%) extremely obese patients were identified. In comparison with obese patients with BMI ≥30-39.9 kg/m2, patients with extreme obesity with BMI ≥40 kg/m2 had similar CV (adjusted HR 1.07, 95% CI 0.75 to 1.50; P = 0.70) and non-CV adverse outcomes (adjusted HR 1.11, 95% CI 0.69 to 1.72; P = 0.65), Figure. Conclusions Obesity is not associated with increased CV mortality or admission following AF ablation. Non-CV events are the major cause of adverse outcomes among obese patients. Identification and reversal, where possible, of non-CV comorbidity may result in improved long-term outcomes following AF ablation. In addition, extremely obese patients with BMI≥40 kg/m2 pose a similar risk of having adverse outcomes to obese patients with BMI≥30-39.9 kg/m2. Thus, patients with extreme obesity should not be excluded from catheter ablation as a management option of AF based solely on their BMI. Abstract Figure. Cumulative-Incidence Curves