open access

Vol 16, No 4 (2021)
Original paper
Published online: 2021-05-18
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Impact of obesity on electrical cardioversion efficacy in patients with persistent atrial fibrillation

Małgorzata Cichoń1, Magdalena Mizia-Szubryt1, Aleksander Owczarek2, Rafał Michalik3, Katarzyna Mizia-Stec1
DOI: 10.5603/FC.a2021.0031
·
Folia Cardiologica 2021;16(4):219-227.
Affiliations
  1. First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
  2. Department of Statistics, Department of Instrumental Analysis, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice
  3. Individual Practice „Fizjocox”, Sosnowiec, Poland

open access

Vol 16, No 4 (2021)
Original Papers
Published online: 2021-05-18

Abstract

Introduction: Obesity’s influence on the effectiveness of electrical cardioversion (CVE) still requires more studies. The study aimed to evaluate the impact of obesity on the efficacy of CVE in atrial fibrillation (AF). Material and methods: Eighty-nine patients [female/male (F/M): 33/56; mean age: 64.66 ± 9.7 years) with persistent symptomatic AF qualified for CVE were prospectively enrolled in the study. CVE efficacy was analyzed immediately after the procedure and in a one-month follow-up. Patients with immediately efficient CVE were divided into obese group [OG; body mass index) BMI ≥ 30 kg/m2, 49 patients, F/M: 21/28, mean age: 64 ± 10 y.) and non-obese group (NOG; BMI < 30 kg/m2, 33 patients, F/M: 9/24, mean age: 66 ± 10 y.). Results: Immediate CVE efficacy was 92%. Sinus rhythm restoration was not BMI-dependent, but BMI had an impact on the amount of energy needed for sinus rhythm restoration (150 J in NOG vs. 200 J in OG, p < 0.05). One-month CVE efficacy was 47%: 38.8% in OG and 60.6% in NOG (p < 0.05). Patients in OG had greater left atrium (LA) and left ventricle (LV) diameters (p < 0.05) and lower left ventricle ejection fraction (LVEF) (p < 0.05) as compared to NOG subjects. Logistic regression analysis revealed LVEF [odds ratio (OR): 1.107, 95% CI: 1.015–1.207, p < 0.05] as a factor influencing one-month CVE efficacy. Conclusions: Immediate high efficacy of CVE in persistent AF seems to be independent of coexisting obesity, however, obesity has an impact on the amount of energy needed for sinus rhythm restoration. One-month efficacy of CVE is low and modified by coexisting obesity.

Abstract

Introduction: Obesity’s influence on the effectiveness of electrical cardioversion (CVE) still requires more studies. The study aimed to evaluate the impact of obesity on the efficacy of CVE in atrial fibrillation (AF). Material and methods: Eighty-nine patients [female/male (F/M): 33/56; mean age: 64.66 ± 9.7 years) with persistent symptomatic AF qualified for CVE were prospectively enrolled in the study. CVE efficacy was analyzed immediately after the procedure and in a one-month follow-up. Patients with immediately efficient CVE were divided into obese group [OG; body mass index) BMI ≥ 30 kg/m2, 49 patients, F/M: 21/28, mean age: 64 ± 10 y.) and non-obese group (NOG; BMI < 30 kg/m2, 33 patients, F/M: 9/24, mean age: 66 ± 10 y.). Results: Immediate CVE efficacy was 92%. Sinus rhythm restoration was not BMI-dependent, but BMI had an impact on the amount of energy needed for sinus rhythm restoration (150 J in NOG vs. 200 J in OG, p < 0.05). One-month CVE efficacy was 47%: 38.8% in OG and 60.6% in NOG (p < 0.05). Patients in OG had greater left atrium (LA) and left ventricle (LV) diameters (p < 0.05) and lower left ventricle ejection fraction (LVEF) (p < 0.05) as compared to NOG subjects. Logistic regression analysis revealed LVEF [odds ratio (OR): 1.107, 95% CI: 1.015–1.207, p < 0.05] as a factor influencing one-month CVE efficacy. Conclusions: Immediate high efficacy of CVE in persistent AF seems to be independent of coexisting obesity, however, obesity has an impact on the amount of energy needed for sinus rhythm restoration. One-month efficacy of CVE is low and modified by coexisting obesity.

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Keywords

obesity, atrial fibrillation, electrical cardioversion, sinus rhythm restoration, electrical cardioversion energy

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About this article
Title

Impact of obesity on electrical cardioversion efficacy in patients with persistent atrial fibrillation

Journal

Folia Cardiologica

Issue

Vol 16, No 4 (2021)

Article type

Original paper

Pages

219-227

Published online

2021-05-18

DOI

10.5603/FC.a2021.0031

Bibliographic record

Folia Cardiologica 2021;16(4):219-227.

Keywords

obesity
atrial fibrillation
electrical cardioversion
sinus rhythm restoration
electrical cardioversion energy

Authors

Małgorzata Cichoń
Magdalena Mizia-Szubryt
Aleksander Owczarek
Rafał Michalik
Katarzyna Mizia-Stec

References (19)
  1. Afshin A, Forouzanfar MH, Reitsma MB, et al. GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017; 377(1): 13–27.
  2. Jia G, Jia Y, Sowers J. Contribution of maladaptive adipose tissue expansion to development of cardiovascular disease. Compr Physiol. 2016: 253–262.
  3. Lubbers ER, Price MV, Mohler PJ. Arrhythmogenic substrates for atrial fibrillation in obesity. Front Physiol. 2018; 9: 1482.
  4. Guglin M, Maradia K, Chen R, et al. Relation of obesity to recurrence rate and burden of atrial fibrillation. Am J Cardiol. 2011; 107(4): 579–582.
  5. Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA. 2013; 310(19): 2050–2060.
  6. Kirchhof P, Benussi S, Kotecha D, et al. ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38): 2893–2962.
  7. Mancia G, Fagard R, Narkiewicz K, et al. Task Force for the Management of Arterial Hypertension of the European Society of Hypertension and the European Society of Cardiology, Task Force Members. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013; 34(28): 2159–2219.
  8. Rydén L, Grant PJ, Anker SD, et al. Authors/Task Force Members, ESC Committee for Practice Guidelines (CPG), Document Reviewers. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013; 34(39): 3035–3087.
  9. Lip GYH, Merino JL, Banach M, et al. Clinical factors related to successful or unsuccessful cardioversion in the EdoxabaN versus warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation (ENSURE-AF) randomized trial. J Arrhythm. 2020; 36(3): 430–438.
  10. Voskoboinik A, Moskovitch J, Plunkett G, et al. Cardioversion of atrial fibrillation in obese patients: results from the cardioversion-BMI randomized controlled trial. J Cardiovasc Electrophysiol. 2019; 30(2): 155–161.
  11. Kang JH, Lee DIn, Kim S, et al. Prediction of long-term outcomes of catheter ablation of persistent atrial fibrillation by parameters of preablation DC cardioversion. J Cardiovasc Electrophysiol. 2012; 23(11): 1165–1170.
  12. Goudis CA, Korantzopoulos P, Ntalas IV, et al. Obesity and atrial fibrillation: a comprehensive review of the pathophysiological mechanisms and links. J Cardiol. 2015; 66(5): 361–369.
  13. Stritzke J, Markus MR, Duderstadt S, et al. MONICA/KORA Investigators. The aging process of the heart: obesity is the main risk factor for left atrial enlargement during aging the MONICA/KORA (monitoring of trends and determinations in cardiovascular disease/cooperative research in the region of Augsburg) study. J Am Coll Cardiol. 2009; 54(21): 1982–1989.
  14. Avelar E, Cloward TV, Walker JM, et al. Left ventricular hypertrophy in severe obesity: interactions among blood pressure, nocturnal hypoxemia, and body mass. Hypertension. 2007; 49(1): 34–39.
  15. Otto ME, Belohlavek M, Khandheria B, et al. Comparison of right and left ventricular function in obese and nonobese men. Am J Cardiol. 2004; 93(12): 1569–1572.
  16. Morricone L, Malavazos AE, Coman C, et al. Echocardiographic abnormalities in normotensive obese patients: relationship with visceral fat. Obes Res. 2002; 10(6): 489–498.
  17. Lavie CJ, Pandey A, Lau DH, et al. Obesity and atrial fibrillation prevalence, pathogenesis, and prognosis: effects of weight loss and exercise. J Am Coll Cardiol. 2017; 70(16): 2022–2035.
  18. Fioravanti F, Brisinda D, Sorbo AR, et al. BMI reduction decreases AF recurrence rate in a Mediterranean cohort. J Am Coll Cardiol. 2015; 66(20): 2264–2265.
  19. Fioravanti F, Brisinda D, Sorbo AR, et al. Compliance in weight control reduces atrial fibrillation worsening: a retrospective cohort study. Nutr Metab Cardiovasc Dis. 2017; 27(8): 711–716.

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