Author + information
- Received December 15, 2011
- Revision received February 27, 2012
- Accepted March 6, 2012
- Published online August 28, 2012.
- Thomas M. Munger, MD⁎,
- Ying-Xue Dong, MD, PhD⁎,†,
- Mitsuru Masaki, MD, PhD⁎,
- Jae K. Oh, MD⁎,
- Sunil V. Mankad, MD⁎,
- Barry A. Borlaug, MD⁎,
- Samuel J. Asirvatham, MD⁎,
- Win-Kuang Shen, MD⁎,
- Hon-Chi Lee, MD, PhD⁎,
- Suzette J. Bielinski, PhD‡,
- David O. Hodge, MS§,
- Regina M. Herges, BS§,
- Traci L. Buescher, RN⁎,
- Jia-Hui Wu, MD∥,
- Changsheng Ma, MD∥,
- Yanhua Zhang, MD¶,
- Peng-Sheng Chen, MD¶,
- Douglas L. Packer, MD⁎ and
- Yong-Mei Cha, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Yong-Mei Cha, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
Objectives The authors sought to characterize the left atrial (LA) and pulmonary vein (PV) electrophysiological and hemodynamic features in obese patients with atrial fibrillation (AF).
Background Obesity is associated with increased risk for AF.
Methods A total of 63 consecutive patients with AF who had normal left ventricular (LV) ejection fraction and who underwent catheter ablation were studied. Atrial and PV electrophysiological studies were performed at the time of ablation with hemodynamic assessment by cardiac catheterization, and LA/LV structure and function by echocardiography. Patients were compared on the basis of body mass index (BMI): <25 kg/m2 (n = 19) and BMI ≥30 kg/m2 (n = 44).
Results At a 600-ms pacing cycle length, obese patients had shorter effective refractory period (ERP) in the left atrium (251 ± 25 ms vs. 233 ± 32 ms, p = 0.04), and in the proximal (207 ± 33 ms vs. 248 ± 34 ms, p < 0.001) and distal (193 ± 33 ms vs. 248 ± 44 ms, p < 0.001) PV than normal BMI patients. Obese patients had higher mean LA pressure (15 ± 5 mm Hg vs. 10 ± 5 mm Hg, p < 0.001) and LA volume index (28 ± 12 ml/m2 vs. 21 ± 14 ml/m2, p = 0.006), and lower LA strain (5.5 ± 3.1% vs. 8.8 ± 2.8%; p < 0.001) than normal BMI patients.
Conclusions Increased LA pressure and volume, and shortened ERP in the left atrium and PV are potential factors facilitating and perpetuating AF in obese patients with AF.
This study was supported by a Mayo Clinic Clinical Research Award for Research in Cardiology and a research grant from St. Jude Medical. Dr. Packer has received the Mayo Clinical Investigator Award for the study of AF ablation outcomes; in the past 12 months, he has provided consulting services for Biosense Webster, Boston Scientific, CyberHeart, Medtronic, nContact, Sanofi-Aventis, St. Jude Medical, and Toray Industries, but received no personal compensation for these consulting activities; and he has received research funding from the National Institutes of Health, Medtronic, CryoCath, Siemens AG, EP Limited, St. Jude Medical, Minnesota Partnership for Biotechnology and Medical Genomics/University of Minnesota, Biosense Webster, and Boston Scientific. Mayo Clinic and Dr. Packer have a financial interest in mapping technology. In accordance with the University and Small Business Patent Procedures (Bayh-Dole) Act, this technology has been licensed to St. Jude Medical and Mayo Clinic, and Drs. Packer and Richard Robb (not an author) have received annual royalties of more than $10,000, the federal threshold for significant financial interest. Dr. Chen is a consultant for Cyberonics, and has received equipment donations from Medtronic, St. Jude Medical, Cyberonics, and Cryocath. Dr. Cha has received a research grant from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 15, 2011.
- Revision received February 27, 2012.
- Accepted March 6, 2012.
- American College of Cardiology Foundation