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Reviews in Cardiovascular Medicine  2021, Vol. 22 Issue (3): 1047-1052     DOI: 10.31083/j.rcm2203114
Special Issue: Clinical Electrophysiology: Diagnosis and Treatment
Original Research Previous articles | Next articles
Influence of excess weight and obesity on performance and outcome of pulmonary vein isolation with the cryoballoon
Christian Blockhaus1, 2, *(), Hans-Peter Waibler1, Jan-Erik Gülker2, 3, Alexander Bufe1, 2, Melchior Seyfarth2, 4, Buelent Koektuerk1, 2, Dong-In Shin1, 2
1Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, 47805 Krefeld, Germany
2Witten-Herdecke University, 58455 Witten, Germany
3Department of Cardiology, Petrus Hospital, 42283 Wuppertal, Germany
4Department of Cardiology, Helios University Hospital, 42283 Wuppertal, Germany
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Abstract:

Pulmonary vein isolation (PVI) has become a cornerstone therapy in the treatment of atrial fibrillation (AF). Patients with overweight or obesity suffer more often from AF, and studies investigating the safety and feasibility of PVI in these patients have shown varying results. In this study we analyzed PVI performed with the 2nd generation cryoballoon (CB) with regard to safety, procedure and fluoroscopy time in patients with normal weight, overweight and obesity. We analyzed 228 consecutive patients treated with CB PVI in our hospital in 2018 and 2019. Fifty nine (25.88%) patients presented with normal weight (body mass index (BMI) of <25), 115 (50.44%) patients with overweight (BMI between 25 and 29.9) and 54 (23.68%) were obese patients (BMI >30). All pulmonary veins (PV) were isolated successfully. Concerning procedural parameters, neither complications, procedural time, nor fluoroscopy time differed significantly. There was a significant increase of dose area product (DAP) in obese patients compared to normal weight and overweight patients (2035.5 ± 1930.1 μGym2 vs. 975.3 ± 814.9 vs. 1325.1 ± 2081.3, p = 0.001) but no significant difference between overweight and normal weight patients (p = 0.611). Our follow-up data of 168 patients (73.68%) observed for 12 months showed no differences in the recurrence of AF in the three BMI groups [80.9% vs. 83.3% (p = 0.733) vs. 86.55% (p = 0.460)]. In conclusion, CB PVI in overweight and obese patients is safe with similar levels of complications and recurrence of AF as patients of normal weight. However, obese patients and operators are exposed to higher radiation doses.

Key words:  Arial fibrillation      Ablation      Arrhythmia      Overweight      Cryoballoon     
Submitted:  08 July 2021      Revised:  20 August 2021      Accepted:  23 August 2021      Published:  24 September 2021     
*Corresponding Author(s):  Christian Blockhaus     E-mail:  christian.blockhaus@helios-gesundheit.de

Cite this article: 

Christian Blockhaus, Hans-Peter Waibler, Jan-Erik Gülker, Alexander Bufe, Melchior Seyfarth, Buelent Koektuerk, Dong-In Shin. Influence of excess weight and obesity on performance and outcome of pulmonary vein isolation with the cryoballoon. Reviews in Cardiovascular Medicine, 2021, 22(3): 1047-1052.

URL: 

https://rcm.imrpress.com/EN/10.31083/j.rcm2203114     OR     https://rcm.imrpress.com/EN/Y2021/V22/I3/1047

Table 1.  Patient’s characteristics of the three body mass index groups.
BMI <25 (n = 59) BMI 25–29.9 (n = 115) BMI >30 (n = 54) p-value
Age (years) 59.9 ± 10.9 61.2 ± 10.1 60.7 ± 9.0 0.649
Sex (male) 41 (69.5%) 85 (73.3%) 34 (63.0%) 0.335
Paroxysmal AF 43 (72.9%) 81 (70.4%) 35 (64.8%) 0.628
Body size (cm) 173.12 ± 10.05 174.41 ± 10.28 172.72 ± 9.87 0.95
Body weight (kg) 69.09 ± 9.94 83.26 ± 10.75 99.61 ± 12.85 <0.001*§¥
CHA2DS2VASC 1.6 ± 1.5 1.7 ± 1.4 2.2 ± 1.5 0.047
EHRA score (2, 3, 4) 25 (42.4%), 26 (44.1%), 8 (13.6%) 41 (35.7%), 58 (50.4%), 16 (13.9%) 17 (31.5%), 29 (53.7%), 8 (14.8%) 0.817
LA-Diameter (mm) 42.6 ± 6.2 44.5 ± 6.7 45.4 ± 7.7 0.120
Anticoagulation (DOAC) 56 (94.9%) 110 (95.7%) 44 (81.5%) 0.008*§
Betablocker 44 (74.6%) 76 (66.1%) 47 (87.0%) 0.0014*§
Arterial hypertension 27 (45.8%) 51 (44.3%) 29 (53.7%) 0.499
Diabetes mellitus II 9 (15.3%) 11 (9.6%) 7 (13.0%) 0.491
Coronary artery disease 7 (11.9%) 15 (13.0%) 9 (16.7%) 0.766
Dyslipidemia 13 (22.0%) 21 (18.3%) 13 (24.1%) 0.619
Legend: *: p-value for BMI >30 vs. BMI >25–29.9: <0.005; §: p-value for BMI >30 vs. <25: <0.005; ¥: p-value for BMI 25–29.9 vs. BMI <25: <0.005.
Table 2.  Procedural data of the three body mass index groups.
BMI <25 (n = 59) BMI 25–29.9 (n = 115) BMI >30 (n = 54) p-value
Complications 2 (3.4%) 2 (1.7%) 1 (1.9%) 0.840
Temp LSPV (C) –49.3 ± 6.1 –49.6 ± 4.9 –49.0 ± 6.4 0.772
Temp LIPV (C) –45.2 ± 4.8 –46.4 ± 5.1 –45.4 ± 5.6 0.202
Temp cLPV (C) –53.7 ± 7.6 –52.6 ± 5.6 –55.8 ± 3.5 0.598
Temp RSPV (C) –51.7 ± 5.0 –51.9 ± 5.9 –50.7 ± 6.6 0.478
Temp RIPV (C) –49.4 ± 6.2 –49.4 ± 6.4 –47.7 ± 7.2 0.172
Procedure time (min) 77.1 ± 18.8 78.1 ± 18.8 80.6 ± 18.6 0.424
Fluoroscopy time (min) 17.2 ± 7.5 17.1 ± 7.2 18.4 ± 7.6 0.662
DAP (µGym²) 975.3 ± 814.9 1325.1 ± 2081.3 2035.5 ± 1930.1 0.001*,§
Legend: *: p-value for BMI >30 vs. BMI >25–29.9: <0.005; §: p-value for BMI >30 vs. <25: <0.005.
Fig. 1.   Kaplan Meier plot at 12 months follow-up of the three body mass index groups.

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