One year clinical and safety outcome of obese patients undergoing pulmonary vein isolation for atrial fibrillation with pulsed field ablation or cryoballoon ablation - a propensity matched analysis.
Sebastian Feickert, Smilla Wagner, Kristof Biernath, Hüseyin Ince, Jasmin Ortak, Andreas A Boehmer, Giuseppe D'Ancona, Niels Christian Ewertsen
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引用次数: 0
Abstract
Background: Thermal-based ablation techniques, such as cryoballoon ablation (CBA), are widely used for pulmonary vein isolation (PVI) but show notable recurrence rates, particularly in obese patients. One possible reason is the reduced efficacy of thermal energy in tissues with significant epicardial fat, which can impede effective lesion formation and insulation of targeted areas.
Objective: Pulsed field ablation (PFA) has shown promising results for atrial fibrillation (AF) treatment, providing effective isolation with a favorable safety profile. This study investigates the clinical and safety outcomes of PFA compared to CBA in obese patients with AF.
Methods: This retrospective propensity-matched study included symptomatic paroxysmal and persistent AF patients with a body mass index (BMI) >30 kg/m2 who underwent PFA or CBA at a single institution. Matching criteria included age, left atrial diameter, left ventricular ejection fraction, and AF type (paroxysmal vs. persistent), as well as pre-existing conditions such as diabetes, coronary artery disease, and hyperlipoproteinemia. Procedural workflows were standardized, focusing on PV isolation. Outcomes assessed were procedural efficiency, recurrence rates, and complications.
Results: Post-matching revealed lower recurrence rates in the PFA group (25%) compared to the CBA group (42.9%, p=0.02). PFA was associated with significantly shorter left atrial (LA) time (33.8 min. vs. 49.7 min., p<0.01) and procedural time (46.8 min. vs. 69.3 min., p<0.01) than CBA, although fluoroscopy time showed no significant difference. Safety outcomes were similar across both groups.
Conclusion: PFA offers an alternative to CBA in obese patients, with superior recurrence outcomes and shorter procedural durations post-matching in this single-center cohort. PFA may be a preferred approach for AF management in this high-risk population. Future randomized trials are warranted to validate these findings and optimize treatment protocols for obese AF patients.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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