ABSTRACT: The aim of this study was to investigate impact of metabolic syndrome (MS) on outcomes of catheter ablation in patients with atrial fibrillation (AF) in terms of recurrence and quality of life (QoL).
MS, a proinflammatory state with hypertension, diabetes, dyslipidemia, and obesity, is presumed to be a close associate of AF.
In this prospective study, 1,496 consecutive patients with AF undergoing first ablation (29% with paroxysmal AF, 26% with persistent AF, and 45% with long-standing persistent AF) were classified into those with MS (group 1; n = 485) and those without MS (group 2; n = 1,011). Patients were followed for recurrence and QoL. The Medical Outcomes Study SF-36 Health Survey was used to assess QoL at baseline and 12 month after ablation.
After 21 ± 7 months of follow-up, 189 patients in group 1 (39%) and 319 in group 2 (32%) had arrhythmia recurrence (p = 0.005). When stratified by AF type, patients with nonparoxysmal AF in group 1 failed more frequently compared with those in group 2 (150 [46%] vs. 257 [35%], p = 0.002); no difference existed in the subgroup with paroxysmal AF (39 [25%] vs. 62 [22%], p = 0.295). Group 1 patients had significantly lower baseline scores on all SF-36 Health Survey subscales. At follow-up, both mental component summary (Δ5.7 ± 2.5, p < 0.001) and physical component summary (Δ9.1 ± 3.7, p < 0.001) scores improved in group 1, whereas only mental component summary scores (Δ4.6 ± 2.8, p = 0.036) were improved in group 2. In the subgroup with nonparoxysmal AF, MS, sex, C-reactive protein ≥0.9 mg/dl, and white blood cell count were independent predictors of recurrence.
Baseline inflammatory markers and the presence of MS predicted higher recurrence after single-catheter ablation only in patients with nonparoxysmal AF. Additionally, significant improvements in QoL were observed in the post-ablation MS population.
Journal of the American College of Cardiology 04/2012; 59(14):1295-301. · 14.16 Impact Factor
ABSTRACT: Obesity increases the risk of atrial fibrillation (AF), and AF seriously impairs the quality of life (QoL). However, it is not known whether body mass index (BMI) has any direct influence on QoL in AF.
To study the association between baseline BMI and QoL improvement in patients with AF following catheter ablation.
Six hundred sixty patients with AF (62 ± 10 years, male 69%, paroxysmal AF 27%, persistent AF 31%, long-standing persistent AF 42%) made up the study population. On the basis of the baseline BMI, patients were categorized into 2 groups: normal (BMI < 25) and overweight/obese (BMI ≥ 25). The QoL survey was done at baseline and at 12-month postablation by using the Medical Outcomes Study Short Form-36 (SF-36), Beck Depression Inventory (BDI), Hospital Anxiety and Depression (HAD) scale, and State-Trait Anxiety Inventory (STAI).
At baseline, dyslipidemia, hypertension, diabetes, coronary artery disease, and large left atrium had higher prevalence in the overweight/obese population. In addition, the preprocedure QoL scores on the SF-36, HAD scale, and STAI were significantly lower in this group than in the normal-BMI group. At the 12-month postablation assessment, no significant improvement in QoL score was noted in the normal-BMI group. However, in the overweight/obese group, QoL scores improved significantly in all scales, except the physical functioning and bodily pain categories of SF-36. Long-term ablation success was not different across the groups (69% normal BMI, 63% high BMI, log-rank P = .109). Patients with successful ablation showed significant improvement in QoL scores compared with those who failed. The multivariable analysis revealed the baseline QoL score and BMI ≥ 25 to be independent predictors of QoL improvement.
Obese patients with AF tend to have a better postablation QoL outcome than do their nonobese counterparts.
Heart rhythm: the official journal of the Heart Rhythm Society 07/2011; 8(12):1847-52. · 4.56 Impact Factor
ABSTRACT: Close association between atrial fibrillation (AF) and brain natriuretic peptide (BNP) has been demonstrated by several studies. Important gender differences exist in AF patients including a higher plasma BNP level in women. Therefore, it is imperative to evaluate the relationship between AF and BNP separately in men and women.
This study examined possible gender-specific role of BNP in predicting procedure outcome in AF patients undergoing catheter ablation.
The study population included 568 consecutive patients (age 62 ± 10, male 73%, paroxysmal 25%, persistent 38%, and long-standing persistent AF 37%) undergoing AF ablation, who had structurally normal heart and left ventricular ejection fraction ≥45%. Baseline BNP was measured in all. Patients were grouped into "normal" and "high" BNP based on gender-specific cut-off values (<50 and ≥50 pg/mL in males, <100 and ≥ 100 pg/mL in females).
Baseline BNP was significantly higher among women than men (126 ± 112 versus 87 ± 99, P = 0.009). At 12 ± 6 month follow-up, 304 of 414 (73%) males and 98 of 154 (64%) females were AF/atrial tachycardia-free off antiarrhythmic drugs (log-rank P = 0.018). In multivariable analysis, BNP remained an independent predictor of AF recurrence (BNP ≥ 50: hazard ratio [HR] 2.54, P = 0.006) in males. No such association was observed among females (BNP ≥ 100: HR 0.79, 95% CI 0.43-1.42; P = 0.426).
Baseline BNP was found to be an independent predictor of AF recurrence in male patients undergoing ablation. This correlation between BNP and AF recurrence was not observed in females. Thus, BNP plays a gender-specific prognostic role in AF.
Journal of Cardiovascular Electrophysiology 03/2011; 22(8):858-65. · 3.06 Impact Factor
ABSTRACT: The proximity of the phrenic nerve (PN) to cardiac tissue relevant to arrhythmias may increase the risk of PN injury. Strategies for preventing PN injury in the pericardial space are limited.
The purpose of this study was to compare methods for separating the PN from the epicardial surface in order to prevent PN injury.
Eight patients referred for epicardial ablation of arrhythmias were enrolled in the study. All patients required ablation near the PN. Endocardial and epicardial access was obtained in all patients. A three-dimensional mapping system was used to guide mapping and ablation. All patients underwent epicardial catheter ablation. Pacing via the ablation catheter identified the location of the PN. In order to prevent PN injury, four new strategies were tested in each patient. We sought to increase the distance between the epicardium and the PN by (1) placing a large-diameter balloon between the nerve and the myocardium, (2) introducing saline in steps of 20 ml until PN capture was lost or blood pressure dropped below 60 mmHg, (3) introducing air until PN capture was lost or blood pressure dropped below 60 mmHg, or (4) introducing a combination of saline and air until PN capture was lost or blood pressure dropped below 60 mmHg.
At each step, epicardial pacing was performed to assess for PN stimulation. The combination of air and saline resulted in the greatest decrease of PN stimulation. Saline only failed in all cases. Air only and balloon placement were infrequently successful.
Controlled and progressive inflation of air and saline together with careful monitoring of hemodynamic parameters appears to be the best strategy for preventing PN injury during epicardial ablation. Placement of a large balloon in the appropriate location can be difficult.
Heart rhythm: the official journal of the Heart Rhythm Society 08/2009; 6(7):957-61. · 4.56 Impact Factor
ABSTRACT: Atrial fibrillation is a common arrhythmia associated with significant morbidity, including angina, heart failure, and stroke. Medical therapy remains suboptimal, with significant side effects and toxicities, and a high recurrence rate. Catheter ablation or modification of the atrioventricular node with pacemaker implantation provides rate-control but exposes patients to the hazards associated with implantable devices and does nothing to reduce the risk for stroke. Pulmonary vein antrum isolation offers a nonpharmacologic means of restoring sinus rhythm, thereby eliminating the morbidity of atrial fibrillation and the need for antiarrhythmic drugs.
Cardiology clinics 03/2009; 27(1):163-78, x. · 1.25 Impact Factor