Background: Catheter ablation of atrial fibrillation (AF) is an increasingly popular
therapeutic option for symptomatic patients who have failed multiple
antiarrhythmic medications. Patients of higher body mass index often
fail direct current cardioversion. The role of body mass index (BMI)
on the success of AF ablation is not well understood.
Methods: We prospectively studied 893 patients who underwent AF
ablation at the Cleveland Clinic Foundation between 1999 and 2003. Patients
were divided into four classes based on their BMI: Class I (≤ 25);
Class II (25.1-30); Class III (30.1-35) and Class IV (>35). They
were compared for baseline demographic and clinical characteristics.
Any recurrence of AF after 3 months of ablation was considered as failure.
All classes were followed for at least 12 months and rates of failure
Results: Based on their BMI, 25% of patients were assigned to class
I, 37% in class II, 21% in class III and 16% in class IV. Patients of
higher classification (class III or IV) were more likely to be male
(p<0.001), diabetic (p<0.001), smokers (p=0.002), with coronary
artery disease (=0.018), echocardiographic evidence of left atrial enlargement
(p=0.015) and longstanding AF (p=0.007). We found a significant correlation
between long-term (one-year) AF recurrence after catheter ablation and
BMI classification with recurrence rates of 5.2% in class I, 7.5% in
class II, 14.1% in class III and 8.4% in class IV (p=0.01). The short-term
recurrence rates of 12.7% in class I, 19.1% in class II, 23.0% in class
III and 17.4% in class IV did not achieve statistical significance (p=0.05)
is significantly associated with long-term AF recurrence after catheter
ablation. Higher incidence of systemic inflammation, smoking & left
atrial enlargement possibly contribute to higher failure rates in this
sub-group of patients.
Credits: Dhanunjaya R. Lakkireddy; George E. Blake; Dimpi Patel; Martin Rotter; Atul Verma; Kay Ryschon; Mohammed Khan; Robert Schweikert; Michel Haissaguerre; Andrea Natale