Abstract 15861: The Role of Body Mass Index in Cryoballoon Ablation Outcomes for Paroxysmal Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Abhishek Bose ◽  
Parag A Chevli ◽  
Zeba Hashmath ◽  
Ajay K Mishra ◽  
Gregory Berberian ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Body Mass ◽  
Paroxysmal Atrial Fibrillation ◽  
Surrogate Marker ◽  
The Body ◽  
Cryoballoon Ablation ◽  
Class 1 ◽  
Study Population ◽  
One Year

Introduction: Cryoballoon ablation (CBA) is recommended for patients with paroxysmal atrial fibrillation (AF) refractory to anti-arrhythmic drugs. However, only 70% of patients benefit from an initial CBA. Obesity is a known risk factor for development of AF but its role in predicting outcomes following CBA for paroxysmal AF remains unclear. Methods: We followed 103 patients (Age 60.6 ± 9.1, 29% women) with paroxysmal AF undergoing CBA for one year post procedure. Recurrence was assessed by documented atrial arrhythmias (AA) on EKG or any form of long-term cardiac rhythm monitoring. Using the body mass index (BMI) as a surrogate marker for obesity, we divided patients into five groups: normal <24.9 kg/m 2 , overweight 25-29.9 kg/m 2 , class 1 obesity 30-34.9 kg/m 2 , class 2 obesity 35-39.9 kg/m 2 and class 3 obesity ≥40 kg/m 2 . A multivariable cox proportional hazard model was used to assess if BMI predicted risk of AA recurrence. Results: Among our study population, 7 (6.7%) had normal BMI and 34 were overweight (33%) while 17 (16.5%), 14 (13.5%) and 8 patients (7.7%) were categorized as class 1, 2 and 3 obesity respectively. After a one year follow up, 19 (18.4%) participants developed recurrence of AA. Baseline demographics were similar between the two groups except for a higher incidence of hypertension in the class 3 obesity group. On a multivariable model adjusted for baseline demographics and risk factors for AF, neither obesity nor overweight predicted recurrence of AA following CBA (Table, p=0.18). Similarly, on Kaplan-Meier analysis, BMI did not effect time to first recurrence of AA (Figure, p=0.07). Conclusion: Obesity is strongly associated with the risk of development of AF. However, in our study population increasing BMI had no influence on the recurrence of AA following CBA for paroxysmal AF.

scholarly journals Ultrasound assessment of muscle mass in the diagnosis of sarcopenia in cardiovascular patients

2021 ◽  
Vol 20 (3) ◽  
pp. 2699
Author(s):  
A. S. Erokhina ◽  
E. D. Golovanova ◽  
M. A. Miloserdov
Keyword(s):  
Body Mass Index ◽  
Muscle Mass ◽  
Body Mass ◽  
Lower Leg ◽  
The Body ◽  
Russian Society ◽  
Speed Test ◽  
European Working ◽  
Class 1 ◽  
Artery Disease

Aim. To study the advantages of ultrasound versus anthropometric assessment of muscle mass for early diagnosis of sarcopenia in patients >45 years of age.Material and methods. The study included 79 patients aged 4589 years with coronary artery disease (CAD), hypertension, type 2 diabetes, heart failure, class 1-3 obesity. Diagnosis of hypertension was carried out according to the European (2018) and Russian (2019) guidelines; CAD — according to Russian Society of Cardiology (2020) guidelines. Sarcopenia was diagnosed according to 2010 European Working Group on Sarcopenia in Older People (EWGSOP) criteria and 2018 EWGSOP2 guidelines. Muscle mass (MM) was determined by two methods: 1 — by measuring the rectus abdominis muscle (RAM) thickness using the ultrasound; 2 — by measuring the arm and lower leg circumference. Muscle strength was determined by wrist dynamometer. Muscle function was assessed using the 4-m gait speed test.Results. The study showed that in patients aged >45 years admitted to the emergency cardiology department, the body mass index exceeded 25 kg/m2 in 88,6% of cases. The incidence of sarcopenia of varying severity was 55,7% (n=44). The differences in RAM thickness, arm and lower leg circumference between the groups of patients with/without sarcopenia were significant (p<0,001), but were less than the threshold only for RAM thickness. RAM thickness levels progressively decreased with increasing severity of sarcopenia and significantly differed at all stages compared to patients without sarcopenia (p<0,001), regardless of body mass index. A decrease in lower leg circumference below the threshold values determining a MM decrease was observed only in severe sarcopenia, and arm circumference — in both men and women only in severe sarcopenia. There were no significant differences for arm and lower leg circumference depending on sarcopenia stages in overweight and obese patients.Conclusion. MM assessment by measuring RAM thickness with ultrasound in comparison with the anthropometric method makes it possible to diagnose sarcopenia in patients >45 years of age with cardiovascular diseases and obesity at earlier stages and to promptly recommend preventive measures.

scholarly journals Efficacy and Safety of Direct Oral Anticoagulants for Atrial Fibrillation Across Body Mass Index Categories

2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Rachel M. Kaplan ◽  
Yoshihiro Tanaka ◽  
Rod S. Passman ◽  
Michelle Fine ◽  
Laura J. Rasmussen‐Torvik ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Body Mass ◽  
Intracranial Hemorrhage ◽  
Oral Anticoagulants ◽  
Efficacy And Safety ◽  
Class 1 ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

Background Direct‐acting oral anticoagulants are now the preferred method of anticoagulation in patients with atrial fibrillation. Limited data on efficacy and safety of these fixed‐dose regimens are available in severe obesity where drug pharmacokinetics and pharmacodynamics may be altered. The objectives of this study were to evaluate efficacy and safety in patients with atrial fibrillation taking direct‐acting oral anticoagulants across body mass index (BMI) categories in a contemporary, real‐world population. Methods and Results We performed a retrospective study of patients with atrial fibrillation at an integrated multisite healthcare system. Patients receiving a direct‐acting oral anticoagulant prescription and ≥12 months of follow‐up between 2010 and 2017 were included. The primary efficacy and safety outcomes were ischemic stroke or systemic embolism and intracranial hemorrhage. We performed Cox proportional hazards modeling to compute hazard ratios (HRs) adjusted for CHA 2 DS 2 ‐VASc score to examine differences by excess BMI categories relative to normal BMI. Of 7642 patients, mean±SD age was 69±12 years with a median (interquartile range) follow‐up of 3.8 (2.2–6.0) years. Approximately 22% had class 1 obesity and 19% had class 2 or 3 obesity. Stroke risks were similar in patients with and without obesity (HR, 1.2; 95% CI, 0.5–2.9; and HR, 0.68; 95% CI, 0.23–2.0 for class 1 and class 2 or 3 obesity compared with normal BMI, respectively). Risk of intracranial hemorrhage was also similar in class 1 and class 2 or 3 obesity compared with normal BMI (HR, 0.64; 95% CI, 0.35–1.2; and HR, 0.66; 95% CI, 0.35–1.2, respectively). Conclusions Direct‐acting oral anticoagulants demonstrated similar efficacy and safety across all BMI categories, even at high weight values.

P373Arterial stiffness changes in patients with obesity and atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Tarzimanova ◽  
V I Podzolkov ◽  
A E Bragina ◽  
M V Pisarev ◽  
R G Gataulin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Arterial Stiffness ◽  
Sinus Rhythm ◽  
Body Mass ◽  
Paroxysmal Atrial Fibrillation ◽  
Obese Patients ◽  
Waist To Hip Ratio ◽  
Group I ◽  
The Mean

Abstract Objective To study the changes in arterial stiffness in patients with obesity and paroxysmal atrial fibrillation (AF). Materials and methods The study included 82 obese patients. Forty-two of them (group I) had paroxysmal AF, their mean age was 60.9 ± 6.2 years. The control group (group II) included 40 obese patients in sinus rhythm with the mean age of 57.2 ± 6.5 years.  We studied arterial stiffness using cardio-ankle vascular index (CAVI) measured by the VaSera device (VS-1000) in all the patients. Patients from group I were evaluated after 3 days of sinus rhythm restoration and maintenance. We also measured the anthropometric indicators which included body mass index, waist circumference, abdominal sagittal diameter, waist-to-hip and waist-to-height ratios. Results There were no significant differences in body mass index between 2 groups. The waist-to-hip ratio was significantly higher in patients with obesity and paroxysmal atrial fibrillation than in obese patients in sinus rhythm and was 1.37 ± 0.09 and 0.84 ± 0.06, respectively (p = 0.002). The mean value of CAVI was 9.61 ± 1.51 and 6.42 ± 0.18 in group I and group II respectively; this difference was significant (p = 0.001). There was a strong positive correlation between CAVI and waist-to-hip ratio in the group I patients (p = 0.02). The results show that vascular stiffness is significantly higher in obesity patients with paroxysmal form AF. Conclusion Positive correlations between increased arterial stiffness and anthropometric indicators confirm the role of visceral obesity in the development of AF.

Is the body mass index a predictor of adverse outcome in prostate cancer after radical prostatectomy in a mid-European study population?

2009 ◽  
Vol 103 (7) ◽  
pp. 877-882 ◽  
Author(s):  
Jesco Pfitzenmaier ◽  
Maria Pritsch ◽  
Axel Haferkamp ◽  
Hildegard Jakobi ◽  
Frederik Fritsch ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Body Mass Index ◽  
Radical Prostatectomy ◽  
Body Mass ◽  
Adverse Outcome ◽  
The Body ◽  
European Study ◽  
Study Population

scholarly journals Correlation of peak expiratory flow rate with body mass index in school children of a government school of Kathmandu

2019 ◽  
Vol 8 (1) ◽  
pp. 37-40
Author(s):  
Archana Nepal
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Peak Expiratory Flow ◽  
Flow Rate ◽  
School Children ◽  
Peak Expiratory Flow Rate ◽  
The Body ◽  
Government School ◽  
Study Population ◽  
Expiratory Flow

Background: Peak expiratory flow rate is a reliable data to assess the severity and effectiveness of management in adolescent with asthma. There is no study done in Nepalese children to relate it with the body mass index. The present study tries to find out its relation with age, sex, weight, height, body mass index. Objectives: To identify the effect of body mass index on peak expiratory flow rate among healthyNepalese school children. Methodology: Three hundred and ten students of a government school at Kalimati wereincluded in this study. Highest of the three peak expiratory flow rate readings were recorded using Wright’s peak flow meter. Questionnaire were used to find out the pre-existing disease conditions for exclusion from the study population. Weight and height were measured using standardized instruments and body mass index was calculated using formula: weight (kg)/height2(m). Results: Peak expiratory flow rate initially increased with increasing body mass index from -1SD to +2SD and it declined as body mass index increased above +2SD. Pearson’s correlation r was positive with values of 0.7, 0.65, 0.64, 0.35 for height, weight, age and body mass index respectively. Height had highest positive correlation with peak expiratory flow rate while body mass index though had positive but weak correlation with peak expiratory flow rate. Conclusion: Body mass index is positively correlated with peak expiratory flow rate. However, mean Peak expiratory flow rate initially increases with increasing body mass index and it starts declining as body mass index reaches overweight range.

scholarly journals A paroxysmalis pitvarfibrilláció kezelésének transzkatéteres ablatiós technikái: új generációs krioballon vagy kontakterő-méréssel kombinált rádiófrekvenciás ablatio?

2016 ◽  
Vol 157 (22) ◽  
pp. 849-854 ◽  
Author(s):  
Zsófia Nagy ◽  
Zsuzsanna Kis ◽  
Zoltán Som ◽  
Csaba Földesi ◽  
Attila Kardos
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Paroxysmal Atrial Fibrillation ◽  
Holter Monitoring ◽  
Pericardial Tamponade ◽  
Cryoballoon Ablation ◽  
Phrenic Nerve Palsy ◽  
Telephone Interviews ◽  
One Year ◽  
New Generation

Introduction: Contact force sensing radiofrequency ablation and the new generation cryoballoon ablation are prevalent techniques for the treatment of paroxysmal atrial fibrillation. Aim: The authors aimed to compare the procedural and 1-year outcome of patients after radiofrequency and cryoballoon ablation. Method: 96 patients with paroxysmal atrial fibrillation (radiofrequency ablation: 58, cryoballoon: 38 patients; 65 men and 31 women aged 28–70 years) were enrolled. At postprocedural 1, 3, 6 and 12 months ECG, Holter monitoring and telephone interviews were performed. Results: Procedure and fluorosocopy time were: radiofrequency ablation, 118.5 ± 15 min and 15.8 ± 6 min; cryoballoon, 73.5 ± 16 min (p<0.05) and 13.8 ± 4.,1 min (p = 0.09), respectively. One year later freedom from atrial fibrillation was achieved in 76.5% of patients who underwent radiofrequency ablation and in 81% of patients treated with cryoballoon. Temporary phrenic nerve palsy occurred in two patients and pericardial tamponade developed in one patient. Conclusions: In this single center study freedom from paroxysmal atrial fibrillation was similar in the two groups with significant shorter procedure time in the cryoballoon group. Orv. Hetil., 2016, 157(22), 849–854.

scholarly journals Genetic Determinants of Increased Body Mass Index Partially Mediate the Effect of Elevated Birth Weight on the Increased Risk of Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Songzan Chen ◽  
Tian Xu ◽  
Fangkun Yang ◽  
Yao Wang ◽  
Kaijie Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Birth Weight ◽  
Body Mass ◽  
The Body ◽  
Sensitivity Analyses ◽  
Genome Wide Association Studies ◽  
Genome Wide ◽  
A Genome ◽  
Increased Risk

Background: Although several observational studies have shown an association between birth weight (BW) and atrial fibrillation (AF), controversy remains. In this study, we aimed to explore the role of elevated BW on the etiology of AF.Methods: A two-sample Mendelian randomization (MR) study was designed to infer the causality. The genetic data on the associations of single-nucleotide polymorphisms (SNPs) with BW and AF were separately obtained from two large-scale genome-wide association studies with up to 321,223 and 1,030,836 individuals, respectively. SNPs were identified at a genome-wide significant level (p &lt;5 × 10−8). The inverse variance-weighted (IVW) method was employed to obtain causal estimates as our primary analysis. Sensitivity analyses with various statistical methods were applied to evaluate the robustness of the results, and multivariable MR analysis was conducted to determine whether this association was mediated by the body mass index (BMI).Results: In total, 144 SNPs were identified as the genetic instrumental variables. MR analysis revealed a causal effect of elevated BW on AF (OR = 1.27, 95% CI = 1.14–1.40, p = 5.70 × 10−6). All the results in sensitivity analyses were consistent with the primary result. The effect of BW on AF was attenuated when adjusted for BMI (OR = 1.16, 95% CI = 1.01–1.33, p = 0.04).Conclusions: This study indicated that elevated BW was significantly associated with increased lifelong risk of AF, which may be partially mediated by BMI.

scholarly journals Impact of body mass index on atrial fibrillation ablation using cryoballoon: procedural data and clinical outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Urbanek ◽  
S Chen ◽  
S Bordignon ◽  
N Tsianakas ◽  
F Bologna ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Pulmonary Vein ◽  
Body Mass ◽  
Pulmonary Vein Isolation ◽  
Clinical Success ◽  
Cryoballoon Ablation ◽  
Group 3 ◽  
The Impact

Abstract Background The impact of body mass index (BMI) on atrial fibrillation (AF) ablation using cryoballoon (CB) has been seldom reported. Purpose To evaluate the impact of BMI on procedural data as well as the clinical efficacy and safety character of using CB. Methods Symptomatic AF patients (paroxysmal / persistent AF) with BMI ≥25 who underwent CB based pulmonary vein isolation (PVI) were enrolled. CB PVI was performed using the second generation CB (CB 2, 28mm), with 4min based freeze protocol and bonus freeze delivery in case of time-to-isolation (TTI) &gt;75 sec. All procedures were performed under conscious sedation. Procedural endpoint was electrical pulmonary vein isolation. Clinical success was defined as no recurrence of AF/atrial tachycardia (AT). Results Data from 600 consecutive patients were collected. Three groups defined: BMI 25–29 (Group 1, G1 n=337); BMI 30–34 (Group 2, G2 n=149); BMI ≥35 (Group 3, G3 n=114). Patients in Group 3 were younger (G1: 67±11 y; G2: 68±10y G3 62±11y; p&lt;0,001) and presented bigger LA (G1 39,5±4,9 mm; G2: 41,6±5,5; G3 42,4±5,1; p&lt;0,001). Most of the patients presented with PAF (G1: 59,3% G2: 57,7% G3: 54,4%). Among 2342 Targeted PVs, 2332 (99,6%) were isolated using solely the CB (G2: one procedure was abolished due to failed aortic puncture during transseptal access; G3: one PVI was not completed due to PNP; 6 touch up RF ablation in G1 and 2 in G3). Procedure time (G1:58,45 min; G2: 60,44 min; G3 63,19 min) and fluoroscopy time (G1: 9,3 min; G2: 9,5 G3: 10,6 min) were comparable among the groups. PN Injury was the main recorded complication: 20/600 (2,6%) patients with a transient PN palsy (PNP) and 6/600 (1%) with a persistent PNP. No sedation related complication was recorded. Follow up survival curve analysis after one year revealed a favorable follow up in G1 (78,4%) and G2 (82,5%) compared to G3 (66,5%) (G1 Vs G3 p: 0,002 G2 vs G3 p=0,008, G1 vs G2 p=0,47). The influence of BMI on the follow up was confirmed in the subgroup of patients with paroxysmal AF but not in patients presenting persistent AF. Conclusions Cryoballoon ablation in obese patients is feasible and associated with a relatively low complication rate. BMI plays a role in predicting recurrences especially in patients presenting with paroxysmal AF. Funding Acknowledgement Type of funding source: None

Abstract P003: Effectiveness And Safety Of Direct Oral Anticoagulants Compared With Warfarin In Patients With Atrial Fibrillation Across Body Mass Index Categories

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Yoshihiro Tanaka ◽  
Sadiya Khan ◽  
Rachel Kaplan ◽  
Philip Greenland ◽  
Rod S Passman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Body Mass ◽  
Intracranial Hemorrhage ◽  
Propensity Scores ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Safety Outcome ◽  
One Year

Background: Although direct oral anticoagulants (DOACs) are preferred for most patients needing anticoagulation for atrial fibrillation (AF), uncertainty remains in the effectiveness and safety of DOACs compared with warfarin in patients with obesity. Available data from large real-word cohorts are lacking. Purpose: To examine the effectiveness and safety of DOACs compared with warfarin in patients with obesity and AF. Methods: We conducted a retrospective cohort study at an integrated, multi-site healthcare system. We included patients with AF prescribed either a DOAC or warfarin with ≥ one year of follow-up between 2010-2017. The primary effectiveness outcome was ischemic stroke or systemic embolism (S/SE) and the primary safety outcome was incident intracranial hemorrhage (ICH). Using logistic regression, we calculated propensity scores (PS) of prescription for DOAC in each body mass index (BMI) category (<25 kg/m2, 25.0-29.9 kg/m2, 30.0 to 34.9 kg/m2, and BMI≥35.0 kg/m2) using the following covariates: age, sex, race, ethnicity, BMI, systolic blood pressure, and CHA 2 DS 2 -VASc score. We used inverse probability weighting (IPW) based on the PS and IPW-weighted hazard ratios with 95% confidence intervals were calculated by Cox proportional hazard model. Results: Of a total of 17,905 patients included, mean (standard deviation [SD]) age was 70 ± 12 years and mean (SD) BMI was 29.9 ± 6.7 kg/m 2 ; nearly half received a prescription for DOAC (42.7%) and 57.3% for warfarin. During median follow-up of 3.8 years (interquartile range: 2.2-6.0), a total of 159 stroke and 376 intracranial hemorrhage events were observed. Patients on DOACs had a similar or lower HRs for both S/SE and ICH events compared with warfarin across each BMI category (Figure). Conclusion: In this retrospective study, DOACs were as safe and effective compared with warfarin across BMI categories in patients with AF.

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