International Journal of Cardiology: Heart & Vasculature (Dec 2024)

Impact of overweight and obesity on radiation dose and outcome in patients undergoing pulmonary vein isolation by cryoballoon and pulsed field ablation

  • Christiane Jungen,
  • Manuel Rattka,
  • Jan Bohnen,
  • Evangelos Mavrakis,
  • Dimitra Vlachopoulou,
  • Sebastian Dorna,
  • Isabel Rudolph,
  • Christina Kohn,
  • Dobromir Dobrev,
  • Tienush Rassaf,
  • Shibu Mathew

Journal volume & issue
Vol. 55
p. 101516

Abstract

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Background: Pulmonary vein isolation (PVI) using pulsed field ablation (PFA) or cryoballoon ablation (CBA) are commonly used single-shot techniques for the treatment of patients with atrial fibrillation (AF). The number of overweight (BMI 25–30 kg/m2) and obese (BMI>30 kg/m2) patients undergoing PVI is increasing, but data on this patient population is limited. Methods: Consecutive AF patients with a BMI ≥25 kg/m2 undergoing PFA- or CBA-PVI were included in this retrospective analysis. Baseline characteristics, procedural parameters and 1-year AF-freedom were retrospectively analyzed and compared for both ablation modalities. Results: Of 115 patients (66 % men, 64 years [IQR: 58–71 years], 57 % overweight and 43 % obese) PFA- was performed in 68 % and CBA-PVI in 32 %. Contrast-dye volume (PFA: 80 ml [IQR: 60 − 117 ml] vs. CBA: 130 ml [IQR: 95 − 200 ml], P=0.001) and radiation exposure (PFA: 2196 cGy·cm2 [IQR: 1398 − 2973 cGy·cm2] vs. CBA: 3239 cGy·cm2 [IQR: 1288 − 5062 cGy·cm2], P=0.009) was lower in patients undergoing PFA-PVI. Logistic regression analysis identified obesity (OR: 5.58, 95 % CI: 1.63–19.06; P=0.006) and CBA-PVI (OR: 12.93, 95 % CI: 3.51–47.68; P<0.001) to be associated with increased radiation exposure. Both techniques were comparably safe (PFA: 4 % vs. CBA: 0 %; P=0.3). The median follow-up time was 145 days [IQR: 103 − 294 days]. AF-freedom after 1-year was similar in overweight (82 %) and obese patients (67 %) (HR: 0.61; 95 % CI: 0.29–1.28; P=0.19) as well as in PFA- and CBA-PVI patients (76 % vs. 76 %, HR: 1.37; 95 % CI: 0.63–2.99; P=0.42). Conclusion: Overweight and obese patients undergoing PFA-PVI had lower contrast-dye volume compared to CBA-PVI. Obesity was associated with increased radiation exposure. Both techniques were comparably safe. The 1-year AF-freedom was similar in overweight and obese patients.

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