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Oxford University Press, EP Europace, Supplement_1(24), 2022

DOI: 10.1093/europace/euac053.211

Springer, Journal of Interventional Cardiac Electrophysiology, 2(65), p. 403-410, 2022

DOI: 10.1007/s10840-022-01210-3

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Procedural and outcome impact of obesity in cryoballoon versus radiofrequency pulmonary vein isolation in atrial fibrillation patients

This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Cryoballoon-(CB)- and radiofrequency-(RF)-ablation are the most common techniques for pulmonary vein isolation (PVI) in patients (pts) with symptomatic atrial fibrillation (AF). An increasing number of pts undergoing PVI are obese. Objective To address the paucity of procedural differences and outcome data of CB- vs. RF-based PVI in relation to body mass index (BMI) of AF patients. Methods All pts undergoing de novo PVI between 01/2018-08/2019 at our university hospital were included in this retrospective analysis. Pts of each group (CB-PVI vs. RF-PVI) were subdivided based on their BMI: normal weight BMI <25kg/m², pre-obesity 25-30kg/m², obesity stage I 30-35kg/m² and severe obesity stage II ≥35kg/m². Hereafter, procedural characteristics and AF recurrence rate during follow-up were compared with regard the different BMI groups. Results A total of 526 pts (62% male, 65.3±11.2 years) underwent successful de novo PVI (320 CB and 206 RF). Especially in obese patients, differences in procedural characteristics were noted: A significantly increased contrast medium volume in CB group (all: CB 50 [40-80] vs. RF 20 [20-30], p<0.001; BMI≥35: CB 70 [54.5-102.5] ml vs. RF 20 [15-30] ml, p<0.001). In line with previous studies, the overall procedure time was significantly shorter with CB-PVI (CB 75 [60-100] vs. RF 120 [110-180], p<0.001). Also, as expected, lower fluoroscopy dose was detected in RF group (all: CB 392.4 [197.9-995.9] vs. RF 282.5 [139.8-507.2], p<0.001). The complication rate was equal throughout all BMI groups. A 12-month follow up was available in 480 of 526 (91%) pts. Freedom from any arrhythmia was comparable between CB-PVI and RF-PVI (CB 77% vs. RF 75%, p=0.63). However, for obese pts a trend towards higher AF recurrence rate after RF- compared to CB-PVI was observed (BMI≥35: CB 24% vs. RF 50%, p=0.099). Conclusion For obese pts CB-PVI is similarly safe and effective as RF-PVI. The significantly shorter procedure time for CB-PVI may minimize potential obesity-related complications. However, the lower contrast medium quantity and fluoroscopy dose in RF-PVI must be considered. AF recurrence rates were comparable between CB-PVI und RF-PVI. Randomised trials are needed to evaluate the long-term freedom of AF recurrence in pts with higher BMI comparing CB- vs. RF-based PVI and possible obesity related complication.