Relation of Morbid Obesity and Female Gender to Risk of Procedural Complications in Patients Undergoing Atrial Fibrillation Ablation

Feb 21, 2013
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Authors:
Shoemaker MB, Muhammad R, Farrell M, et al.
Citation:
Am J Cardiol 2013;111:368-373.
Summary By:
Fred Morady, MD, FACC

Study Questions:

Does morbid obesity increase the risk of complications in patients undergoing catheter ablation of atrial fibrillation (AF)?

Methods:

This was a retrospective analysis of procedural complications in 445 patients who underwent catheter ablation of AF. Obesity was defined as a body mass index (BMI) of 30-40 kg/m2 and morbid obesity as a BMI >40 kg/m2.

Results:

A total of 512 ablation procedures were performed: 260 in patients (mean age 61 years) with a BMI <30 kg/m2, 210 in patients (mean age 57 years) who were obese, and 42 in patients (mean age 56 years) who were morbidly obese. The major complication rate was significantly higher in morbidly obese patients (14.3%) than in nonmorbidly obese patients (6.2%). Morbidly obese women had a significantly higher complication rate (25%) than morbidly obese men (7.7%). The independent predictors of a major complication were morbid obesity (odds ratio [OR], 3.1) and female gender (OR, 2.1).

Conclusions:

The authors concluded that in patients undergoing catheter ablation of AF, morbid obesity is associated with a higher complication rate, especially in women.

Perspective:

Morbid obesity is likely to have its greatest impact on complications related to vascular access. Because catheter manipulation may be more challenging in morbidly obese patients, the risk of left atrial perforation also may be higher. Moreover, if tamponade does occur, emergency pericardiocentesis can be much more difficult to accomplish in morbidly obese patients.

Keywords: Body Mass Index, Body Composition, Obesity, Morbid, Pulmonary Veins, Catheter Ablation, Pericardiocentesis


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