Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

D-PO02-131 - Cryoballoon-based Pulmonary Vein Isolation In Obese Versus Normal Weight Patients: Notable Differences, Data From A Single Center Registry (ID 220)

Abstract

Background: Cryoballoon-based (Cryo) pulmonary vein isolation (PVI) is a standard therapy for patients (pts) with atrial fibrillation (AF).
Objective: We sought to assess the impact of body mass index (BMI) on AF recurrence and procedural characteristics.
Methods: All pts undergoing de novo Cryo PVI between January 2018 and August 2019 at the University Hospital of Cologne were included in this retrospective analysis. We predefined a subgroup analysis of normal weight BMI <25, pre-obesity 25-30, obesity stage I 30-35 and obesity stage II ≥35kg/m².
Results: In this period 322 Cryo PVI (62% of all de novo PVI) were successfully performed (average age 65±11.6 years, 62% male, 40% persistent AF). The BMI distribution (BMI <25, 25-30, 30-35, ≥35 kg/m²) was 102 (32%), 122 (38%), 69 (21%) and 29 (9%) pts. In pts with BMI≥35 the total freeze duration to achieve PVI is significantly longer compared to normal weight pts (BMI<25 vs BMI≥35: 994.7 sec vs 1182.4 sec, p=0.02). In addition, in pts with a BMI≥35 there was a trend towards a higher number of freezes needed to achieve PVI (BMI<25: 5.6 vs BMI≥35: 6.5, p=0.07). Significantly more contrast medium (BMI<25: 60.7 ml vs BMI≥35: 80.2 ml, p=0.02) and higher fluoroscopy doses were detected in severely obese pts (BMI<25: 689.9 μGy x m² vs BMI≥35: 1511.5 μGy x m², p=0.03). The total procedure time and overall complication rate (BMI<25: 1.9%, BMI≥35: 3.4%) did not significantly differ regardless of the BMI group. Pts with a higher BMI had an increased risk of AF recurrence after three months (BMI<25: 35% vs BMI≥35: 47%; p=0.30). In pts with persistent AF this trend was also observed (BMI<25: 34% vs BMI≥35: 63%; p=0.15), however the trend was not statistically significant.
Conclusion: A de-novo Cryo PVI in obese and severely obese pts is safe and effective. However, to achieve complete PVI the Cryo-freeze duration is significantly longer in severely obese pts (BMI≥35) as compared to normal weight pts (BMI<25). Therefore, increasingly used curtailed Cryo-protocols might not be applicable for severely obese pts. Also, significantly more contrast medium is used in BMI≥35 pts, hence renal function should be monitored continuously after Cryo PVI. Based on a limited follow up, recurrences rate of AF in obese pts after Cryo PVI seems to be comparable to previous data.
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