Poor glycemic control in diabetic patients increases the risk of recurrent atrial arrhythmia and cardiovascular hospitalizations among morbidly obese patients undergoing atrial fibrillation ablation

Abstract Background/Introduction Obesity and atrial fibrillation (AF) coexist and share multiple cardiovascular risk factors. Lifestyle modifications can reduce AF burden in obese patients. However, the time invested in pursing lifestyle changes may delay AF ablation, which could negate the procedural benefit. Purpose To examine the effects of lifestyle modifications and the timing of catheter ablation on morbidly obese patients with AF. Methods This retrospective study included 217 consecutive AF patients with a body mass index (BMI) ≥35 kg/m2 undergoing AF ablation at a tertiary care center from 2012 to 2019. Modifiable risks were examined, including the time from AF diagnosis to ablation, fluctuation of BMI >5% or an increase in BMI >3% prior to ablation, mean systolic blood pressure >130 mmHg or diastolic blood pressure >80 mmHg, obstructive sleep apnea with CPAP noncompliance, hyperlipidemia without statin therapy, tobacco use, excessive alcohol use, and diabetes mellitus with hemoglobin A1c (HbA1c) ≥6.5%. The primary outcome was a composite of recurrent atrial arrhythmias and cardiovascular (CV) hospitalizations following AF ablation. A multivariate analysis adjusting for age, gender and modifiable risks was performed. Results The mean age was 61±9 years old, 58% were female and 45% had persistent AF. A substantial portion of the study patients had modifiable risk factors, ranging from 2.7% with excessive alcohol use to 67.3% experiencing delayed AF ablation, Figure 1. The median time from diagnosed AF to ablation was 1.3 years. During a mean follow-up of 2.9 years after AF ablation, 136 (62.7%) patients met the primary outcome. Only HbA1c ≥6.5% was an independent risk factor with adjusted hazard ratio of 1.57, 95% confidence interval 1.02–2.36, P=0.0412, Figure 2A. Delayed AF ablation did not alter the outcome, Figure 2B. There was no interaction between time of ablation and HbA1c ≥6.5% (P=0.67). Conclusion Substantial portions of morbidly obese patients undergoing AF ablation have potentially modifiable risk factors. Poor glycemic control with HbA1c ≥6.5% predicts an increased risk of recurrent atrial arrhythmias and CV hospitalizations, while delayed AF ablation does not. This finding underscores an importance of optimizing HbA1c in morbidly obese patients with AF to reduce adverse outcomes after ablation. FUNDunding Acknowledgement Type of funding sources: None.

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Association between pre-ablation bariatric surgery and atrial fibrillation recurrence in morbidly obese patients undergoing atrial fibrillation ablation

EP Europace ◽

10.1093/europace/euz183 ◽

2019 ◽

Vol 21 (10) ◽

pp. 1476-1483 ◽

Cited By ~ 19

Author(s):

Eoin Donnellan ◽

Oussama M Wazni ◽

Mohamed Kanj ◽

Bryan Baranowski ◽

Paul Cremer ◽

...

Keyword(s):

Atrial Fibrillation ◽

Bariatric Surgery ◽

Propensity Score ◽

Multivariable Analysis ◽

Morbidly Obese ◽

Obese Patients ◽

Af Ablation ◽

The Impact ◽

Af Recurrence

Abstract Aims Obesity decreases arrhythmia-free survival after atrial fibrillation (AF) ablation by mechanisms that are not fully understood. We investigated the impact of pre-ablation bariatric surgery (BS) on AF recurrence after ablation. Methods and results In this retrospective observational cohort study, 239 consecutive morbidly obese patients (body mass index ≥40 kg/m2 or ≥35 kg/m2 with obesity-related complications) were followed for a mean of 22 months prior to ablation. Of these patients, 51 had BS prior to ablation, and our primary outcome was whether BS was associated with a lower rate of AF recurrence during follow-up. Adjustment for confounding was performed with multivariable Cox proportional hazard models and propensity-score based analyses. During a mean follow-up of 36 months after ablation, 10/51 patients (20%) in the BS group had recurrent AF compared with 114/188 (61%) in the non-BS group (P < 0.0001). In the BS group, 6 patients (12%) underwent repeat ablation compared with 77 patients (41%) in the non-BS group, (P < 0.0001). On multivariable analysis, the association between BS and lower AF recurrence remained significant. Similarly, after weighting and adjusting for the inverse probability of the propensity score, BS was still associated with a lower hazard of AF recurrence (hazard ratio 0.14, 95% confidence interval 0.05–0.39; P = 0.002). Conclusion Bariatric surgery is associated with a lower AF recurrence after ablation. Morbidly obese patients should be considered for BS prior to AF ablation, though prospective multicentre studies should be performed to confirm our novel finding.

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Randomized comparison between dexmedetomidine–remifentanil and midazolam–fentanyl for deep sedation during catheter ablation of atrial fibrillation

International Journal of Arrhythmia ◽

10.1186/s42444-019-0002-3 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Young Choi ◽

Sung-Hwan Kim ◽

Ju Youn Kim ◽

Youmi Hwang ◽

Tae-Seok Kim ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Primary Outcome ◽

Secondary Outcome ◽

Positive Pressure ◽

Efficacy And Safety ◽

Af Ablation ◽

Hemodynamic Compromise ◽

3D Mapping System ◽

Sedative Agents

Abstract Background and objectives The efficacy of dexmedetomidine for radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has not been well established. We evaluated the efficacy and safety of sedation using dexmedetomidine with remifentanil compared to conventional sedative agents during RFCA for AF. Subjects and methods A total of 240 patients undergoing RFCA for AF were randomized to either the dexmedetomidine (DEX) group (continuous infusion of dexmedetomidine and remifentanil) or the midazolam (MID) group (intermittent injections of midazolam and fentanyl) according to sedative agents. Non-invasive positive pressure ventilation was applied to all patients during the procedure. The primary outcome was patient movement during the procedure resulting in a 3D mapping system discordance, and the secondary outcome was adverse events including respiratory or hemodynamic compromise. Results During AF ablation, the incidence of the primary outcome was significantly reduced for the DEX group (18.2% vs. 39.5% in the DEX and the MID groups, respectively, p < 0.001). The frequency of a desaturation event (oxygen saturation < 90%) did not significantly differ between the two groups (6.6% vs. 1.7%, p = 0.056). However, the incidences of hypotension not owing to cardiac tamponade (systolic blood pressure < 80 mmHg, 19.8% vs. 8.4%, p = 0.011) and bradycardia (HR < 50 beats/min: 39.7% vs. 21.8%, p = 0.003) were higher in the DEX group. All efficacy and safety results were consistent within the predefined subgroups. Conclusion The combined use of dexmedetomidine and remifentanil provides higher stability sedation during AF ablation, but can lead to more frequent hemodynamic compromise compared to midazolam and fentanyl.

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Prevention of atrial fibrillation – non-modifiable and modifiable risk factors for AF

In a good rythm ◽

10.5604/01.3001.0014.2845 ◽

2020 ◽

Vol 2 (55) ◽

pp. 14-19

Author(s):

Agnieszka Wojdyła-Hordyńska ◽

Grzegorz Hordyński

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Cardiovascular Diseases ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Combined Treatment ◽

Lifestyle Changes ◽

Modifiable Risk Factors

Atrial fibrillation is one of the most common arrhythmias, with a significant increase in incidence in recent years. AF is a major cause of stroke, heart failure, sudden cardiac death, and cardiovascular disease. Timely intervention and modification of risk factors increase chance to stop the disease. Aggressive, multilevel prevention tactics are a component of combined treatment, including – in addition to lifestyle changes, anticoagulant therapy, pharmacotherapy and invasive anti-arrhythmic treatment – prevention of cardiovascular diseases, hypertension, ischemia, valvular disease and heart failure.

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Thoracoscopic surgical atrial fibrillation ablation in patients with an extremely enlarged left atrium

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-021-01056-1 ◽

2021 ◽

Author(s):

Jolien Neefs ◽

Robin Wesselink ◽

Nicoline W. E. van den Berg ◽

Jonas S. S. G. de Jong ◽

Femke R. Piersma ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Antiarrhythmic Drugs ◽

Primary Outcome ◽

Volume Index ◽

Substantial Part ◽

Atrial Tachyarrhythmia ◽

Af Ablation ◽

Male Patients

Abstract Purpose Efficacy of pulmonary vein isolation (PVI) for atrial fibrillation (AF) decreases as left atrial (LA) volume increases. However, surgical AF ablation with unknown efficacy is being performed in patients with a giant LA (GLA). We determined efficacy of thoracoscopic AF ablation in patients with compared to without a GLA. Methods Patients underwent thoracoscopic PVI with additional left atrial ablations lines (in persistent AF) and were prospectively followed up. GLA was defined as LA volume index (LAVI) ≥ 50 ml/m2. Follow-up was performed with ECGs and 24-h Holters every 3 months. After a 3-month blanking period, all antiarrhythmic drugs were discontinued. The primary outcome was freedom of any atrial tachyarrhythmia ≥ 30 s during 2 years of follow-up. Results At baseline, 68 (15.4%) patients had a GLA (LAVI: 56.7 [52.4–62.8] ml/m2), while 374 (84.6%) had a smaller LA (LAVI: 34.8 [29.2–41.3] ml/m2). GLA patients were older (61.9 ± 6.9 vs 59.4 ± 8.8 years, p = 0.02), more often diagnosed with persistent AF (76.5% vs 58.6%, p = 0.008). Sex was equally distributed (with approximately 25% females). GLA patients had more recurrences compared to non-GLA patients at 2-year follow-up (42.6% vs 57.2%, log rank p = 0.02). Freedom of AF was 69.0% in non-GLA paroxysmal AF patients compared to 43.8–49.3% in a combined group of GLA and/or persistent AF patients(log rank p < 0.001). Furthermore, freedom was 62.4% in non-GLA male patients, compared to 43.8–47.4 in a combined group of GLA and/or female sex(log rank p = 0.02). Conclusion Thoracoscopic AF ablation is an effective therapy in a substantial part of GLA patients. Thoracoscopic AF ablation may serve as a last resort treatment option in these patients.

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