Increased body mass index, age, and left atrial size are associated with altered intracardiac atrial electrograms in persistent atrial fibrillation patients

Abstract Funding Acknowledgements No conflicts of interest INTRODUCTION Evidence has shown that obesity, expressed as high body mass index (BMI), is associated with the development of atrial fibrillation(AF). However, the relationship between BMI and recurrence of AF after catheter ablation(CA) remains controversial. Understanding this relationship, may help in regard to patient(p) counseling and management before and after CA. Purpose To evaluate single center AF recurrences after pulmonary vein isolation according to BMI status. Secondary endpoints were to compare the influence of other comorbilitys such as pulmonar disease or obstructive sleep apnea(OSA) METHODS We included 114p with AF(54,5 ± 9,6 years; male 75,4%; paroxysmal 70,2%; persistent 29,8%) treated with first time radiofrequency ablation between 2013 and 2018. On the basis of the baseline BMI, patients were categorized into 2 groups: normal/overweigth (BMI < 30kg/m2) and obese(BMI≥30kg/m2). RESULTS There was no significant difference between the majority of baseline characteristics of the groups (table 1), however patients with BMI≥30 were more likely to sufferd OSA(34% vs 8,2%:p = 0,001), to have larger left atrial (diameter > 40mm: 70,5% vs 46,3%;p = 0,004), and persistent AF (43,4% vs 18%; p 0,004). During 12 months of follow-up AF recurred in 34p (29,8%), the freedom from AF was significantly higher in the BMI < 30 group (48p(80%) vs 31(58,5%), p = 0,015). Multivariate analysis including variables of type of AF, OSA, BMI, left atrial size, ejection fraction, and hypertension demonstrated that BMI was the strongest predictor of being freedom from recurrent AF (OR = 0.35, 95% CI: 0,11–0,81, P = 0.014). A serious complication occurred in 6p(5,3%), with no relationship to BMI. CONCLUSION This study suggest that tight association between obesity and AF recurrence after ablation may be partly due to other concomitant conditions which in turn are more frequent in obese patients like OSA, left atrial size and presence of persistent AF. Abstract Table 1

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Relation of Body Mass Index and Gender to Left Atrial Size and Atrial Fibrillation

The American Journal of Cardiology ◽

10.1016/j.amjcard.2017.04.013 ◽

2017 ◽

Vol 120 (2) ◽

pp. 218-222 ◽

Cited By ~ 13

Author(s):

Gary Huang ◽

Puja B. Parikh ◽

Aditi Malhotra ◽

Luis Gruberg ◽

Smadar Kort

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Body Mass ◽

Left Atrial ◽

Left Atrial Size ◽

Atrial Size ◽

And Gender

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HOLTER MONITORING AND ECHOCARDIOGRAPHY FOR PREDICTING THE EFFECTIVENESS OF PULMONARY VIEN ISOLATION IN PATIENTS WITH PAROXYSMAL AND PERSISTENT ATRIAL FIBRILLATION

Complex Issues of Cardiovascular Diseases ◽

10.17802/2306-1278-2018-7-3-12-23 ◽

2018 ◽

Vol 7 (3) ◽

pp. 12-23

Author(s):

A. V. Tregubov ◽

Yu. V. Shubik

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Persistent Atrial Fibrillation ◽

Holter Monitoring ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Left Atrial Size ◽

Ventricular Ejection Fraction ◽

Atrial Size ◽

The Impact

Aim. To evaluate the impact of the atrial ectopic activity and left ventricular diastolic dysfunction on predicting the effectiveness of pulmonary vein isolation (PVI) in patients with paroxysmal and persistent atrial fibrillation (AF).Methods. 54 patients with paroxysmal and persistent AF and the normal left ventricular ejection fraction were included in the study. Patients underwent Holter monitoring and echocardiography prior to the intervention to identify the predictors of successful PVI. The follow-up was 12 months after the indexed procedure. The effectiveness of treatment was assessed from the third month of the postoperative period. The criterion of the successful treatment was the absence of the AF paroxysms lasting more than 30 seconds, confirmed by Holter, diurnal and / or multi-day monitoring. The Student's t-test was used to assess the reliability of the differences between the variables characterizing the treatment results in the study groups. The discriminant analysis was performed to develop an algorithm that allows predicting the PVI result. A p value <0.05 was considered statistically significant.Results. Premature atrial contraction over 70 per hour can be considered as the predictor of the successful PVI in patients with normal left atrial size. The severe LA enlargement should be considered as a predictor of poor ablation efficacy. The obtained discriminant function allows predicting the effectiveness of PVI in patients with paroxysmal and persistent AF depending on Holter monitoring and echocardiography. Its sensitivity is high for both predicting success and failure of the intervention.Conclusion. Holter monitoring and echocardiography allow predicting the effectiveness of PVI. The intervention's efficacy in the groups of patients with severe LA enlargement and the combination of normal left atrial size with over 70 PAC per hour should be addressed in the further studies.

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No Correlation Between Atrial Natriuretic Peptide Concentrations and Echocardiographic Measurements of Left Atrial Size or Left Ventricular Size and Function in Patients with Persistent Atrial Fibrillation

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2005.00009.x ◽

2005 ◽

Vol 28 (s1) ◽

pp. S110-S114 ◽

Cited By ~ 4

Author(s):

BEATA WOŻAKOWSKA-KAPLON ◽

GRZEGORZ OPOLSKI

Keyword(s):

Atrial Fibrillation ◽

Atrial Natriuretic Peptide ◽

Natriuretic Peptide ◽

Left Atrial ◽

Persistent Atrial Fibrillation ◽

Left Ventricular ◽

Ventricular Size ◽

Left Atrial Size ◽

Atrial Size ◽

And Function

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Abstract 15901: Radiofrequency Ablation for Persistent Atrial Fibrillation: Earlier Catheter-based Interventions are associated With Better Outcomes and in Direct Association With Markers of Pathways of Atrial Remodeling

Circulation ◽

10.1161/circ.132.suppl_3.15901 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Amr F Barakat ◽

Ayman A Hussein ◽

Mohammed Bassiouny ◽

Ali Hakim ◽

Shadi Al Halabi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Persistent Atrial Fibrillation ◽

Atrial Remodeling ◽

Success Rates ◽

Left Atrial Size ◽

Ablation Time ◽

Atrial Size ◽

Direct Association ◽

First Diagnosis

Introduction: Persistent atrial fibrillation (PerAF) ablation has been associated with significant recurrence rates which could reflect progressive AF-related atrial remodeling. We hypothesized that the first-diagnosis to ablation time for PerAF is a major determinant of success rates and in direct association with pathways of atrial remodeling. Methods: Two-year outcomes were assessed in 1241 patients undergoing first time ablation of PerAF between January 2005 and December 2012 at our institution. The time intervals between the first diagnosis of PerF and the ablation procedures were determined. Patients had echocardiograms and measures of B-type natriuretic peptide (BNP) and C-reactive protein (CRP) before the ablation procedures. During ablations, patients with atrial scarring by voltage were identified. Results: The median time-to-ablation since the first PerAF diagnosis was 3 years (interquartile range 1-6.5). With longer diagnosis-to-ablation time (based on quartiles), there was a significant increase in BNP levels (p=0.01), CRP levels (p<0.0001), left atrial size (p=0.03) and scarring (p=0.04). Atrial arrhythmia recurred after a single ablation in 555 patients (44.7%); and 364 (29.3%) underwent repeat ablations. At last follow-up, 1005 patients (81.0%, 390 on antiarrhythmic medications) were either arrhythmia free or had their arrhythmia controlled. In Cox Proportional Hazard analyzes, BNP levels, CRP levels, left atrial size and scarring were associated with arrhythmia recurrence. The diagnosis-to-ablation time had the strongest association with success rates which persisted in multivariate Cox analyzes (HR for recurrence per +1Log diagnosis-to-ablation time 1.25, 95%CI 1.11-1.42, p<0.0001; 4th vs. 1st quartile 2.27, 95%CI 1.52-3.47, p<0.0001). Conclusions: The success rates with PerAF ablation are highest with early intervention, that is ablation before the progression of atrial remodeling.

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