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Vrachatis DA, Papathanasiou KA, Kazantzis D, Anagnostopoulos I, Kousta M, Giotaki SG, Deftereos G, Lambadiari V, Giannopoulos G, Basdra EK, Papaioannou TG, Siasos G, Deftereos S. Cryoballoon Pulmonary Vein Isolation in Obese Patients with Atrial Fibrillation Compared to Non-Obese Counterparts: A Meta-Analysis. Biomedicines 2025; 13:298. [PMID: 40002711 PMCID: PMC11852532 DOI: 10.3390/biomedicines13020298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Revised: 01/18/2025] [Accepted: 01/22/2025] [Indexed: 02/27/2025] Open
Abstract
Introduction: Obesity is an important risk factor for atrial fibrillation (AF) development. Data on cryoballoon ablation (CBA) outcomes in obese patients have so far been scarce. We reviewed the existing literature to compare the efficacy and safety of CBA in obese versus non-obese AF patients. Methods: A systematic literature search was conducted for studies comparing clinical outcomes (arrhythmia recurrence and/or procedural data and/or safety outcomes) between obese and non-obese patients undergoing CBA for AF. Statistical pooling was performed according to a random-effects model with generic inverse-variance weighting of relative risks (RRs) and standardised mean differences (SMDs) computing risk estimates with 95% confidence intervals (CIs). Results: Obese and non-obese patients had comparable arrhythmia recurrence rates (normal versus overweight, RR = 0.95, 95% CI: 0.82-1.11, p = 0.55, I2% = 91%; normal versus class I obesity, RR = 0.97, 95% CI: 0.82-1.13, p = 0.68, I2% = 87%; normal versus class II obesity, RR = 0.98, 95% CI: 0.91-1.07, p = 0.29, I2% = 65%). Procedure time was marginally increased in obese patients compared to non-obese counterparts (normal versus overweight, SMD = 0.05, 95% CI: -0.15-0.26, p = 0.62, I2% = 74%; normal versus class I obesity, SMD = 0.10, 95% CI: -0.00-0.19, p = 0.06, I2% = 2%; overweight versus class I obesity, SMD = 0.11, 95% CI: 0.01-0.21, p = 0.048, I2% = 25%). Regarding radiation exposure, fluoroscopy time was increased in patients with class I obesity compared to normal-weight or overweight patients and dose area product was also increased in obese patients compared to non-obese patients. Lastly, the risk of complications did not differ between obese and non-obese patients. Statistical heterogeneity and the small number of patients included are the main limitations of this study. Conclusion: CBA seems to be effective for obese patients suffering from AF, featuring also similar safety outcomes with non-obese individuals. Radiation exposure was increased in obese patients.
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Affiliation(s)
- Dimitrios A. Vrachatis
- Eugenideio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.A.V.); (I.A.); (M.K.); (S.G.G.); (G.D.); (E.K.B.); (S.D.)
- Department of Biomedical Engineering, National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece;
| | - Konstantinos A. Papathanasiou
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 12462 Athens, Greece
| | - Dimitrios Kazantzis
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK;
| | - Ioannis Anagnostopoulos
- Eugenideio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.A.V.); (I.A.); (M.K.); (S.G.G.); (G.D.); (E.K.B.); (S.D.)
| | - Maria Kousta
- Eugenideio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.A.V.); (I.A.); (M.K.); (S.G.G.); (G.D.); (E.K.B.); (S.D.)
| | - Sotiria G. Giotaki
- Eugenideio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.A.V.); (I.A.); (M.K.); (S.G.G.); (G.D.); (E.K.B.); (S.D.)
| | - Gerasimos Deftereos
- Eugenideio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.A.V.); (I.A.); (M.K.); (S.G.G.); (G.D.); (E.K.B.); (S.D.)
| | - Vaia Lambadiari
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 12462 Athens, Greece;
| | - George Giannopoulos
- Third Department of Cardiology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Efthimia K. Basdra
- Eugenideio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.A.V.); (I.A.); (M.K.); (S.G.G.); (G.D.); (E.K.B.); (S.D.)
- Department of Biological Chemistry, National and Kapodistrian University of Athens, Medical School, 12462 Athens, Greece
| | - Theodore G. Papaioannou
- Department of Biomedical Engineering, National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece;
| | - Gerasimos Siasos
- Third Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece;
| | - Spyridon Deftereos
- Eugenideio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.A.V.); (I.A.); (M.K.); (S.G.G.); (G.D.); (E.K.B.); (S.D.)
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 12462 Athens, Greece
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Papathanasiou KA, Vrachatis DA, Kossyvakis C, Giotaki SG, Deftereos G, Kousta M, Anagnostopoulos I, Avramides D, Giannopoulos G, Lambadiari V, Siasos G, Deftereos S. Impact of Body Mass Index on the Outcomes of Cryoballoon Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation. Clin Pract 2024; 14:2463-2474. [PMID: 39585020 PMCID: PMC11587088 DOI: 10.3390/clinpract14060192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 11/05/2024] [Accepted: 11/08/2024] [Indexed: 11/26/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is prevalent among obese patients, and cryoballoon ablation (CBA) is an effective strategy for the rhythm control of AF. The impact of body mass index (BMI) on the clinical outcomes of CBA for AF is not fully explored. METHODS 85 consecutive patients with paroxysmal AF were enrolled and were categorized into three groups as per their BMI: normal weight (BMI 18.5-25 kg/m2), overweight (BMI 25-30 kg/m2), and obese patients (BMI > 30 kg/m2). The primary study endpoint was a late (12 month) recurrence of AF. Early recurrence of AF, symptom improvement, and procedural outcomes were some key secondary outcomes. RESULTS 20 patients had normal weight, 35 were overweight, and 30 were obese. Obese patients featured a higher prevalence of diabetes mellitus, heavier exposure to smoking, and worse baseline symptoms (as assessed through EHRA class at admission and 12 months before CBA) compared to overweight and normal weight patients. Both late and early (<3 months) AF recurrence rates were comparable across the three groups. Of note, obese patients showed greater improvement in their symptoms post-CBA, defined as improvement by at least one EHRA class, compared to normal weight patients; this might be explained by improved diastolic function. Total procedure time and dose area product were significantly increased in obese patients. The multivariate logistic regression analysis indicated that early AF recurrence and the duration of hypertension are independent predictors of late AF recurrence. CONCLUSION CBA is effective in overweight and obese patients with paroxysmal AF. Procedure time and radiation exposure are increased in obese patients undergoing CBA.
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Affiliation(s)
| | - Dimitrios A. Vrachatis
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Charalampos Kossyvakis
- Department of Cardiology, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece
| | - Sotiria G. Giotaki
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Gerasimos Deftereos
- Department of Cardiology, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece
| | - Maria Kousta
- Department of Cardiology, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece
| | | | - Dimitrios Avramides
- Department of Cardiology, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece
| | - George Giannopoulos
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 12462 Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Rodríguez Muñoz D, Marco del Castillo Á, Rajjoub Al-Mahdi EA, Lázaro Rivera C, Guisasola Cienfuegos M, Ramos Jiménez J, Borrego Bernabé L, Arribas Ynsaurriaga F, Salguero-Bodes R. Systematic Workflow and Electrogram guidance to reduce X-ray Exposure Time during cryoballoon ablation of atrial fibrillation: the SWEET-Cryo strategy. Europace 2023; 25:euad231. [PMID: 37497862 PMCID: PMC10443437 DOI: 10.1093/europace/euad231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
AIMS Cryoballoon pulmonary vein isolation (CB-PVI) offers similar efficacy to point-by-point radiofrequency PVI for patients with atrial fibrillation (AF), but generally with higher X-ray exposure. Strategies aimed at reducing fluoroscopy mostly rely on other costly imaging techniques, limiting their applicability. We designed a Systematic Workflow and Electrogram guidance to reduce X-ray Exposure Time during CB-PVI (SWEET-Cryo) strategy and analysed its impact on fluoroscopy use and acute procedural and clinical outcomes. METHODS AND RESULTS We enrolled 100 patients with paroxysmal or persistent AF undergoing CB-PVI by two operators with different levels of expertise. Patients treated with the SWEET-Cryo strategy (prospective cohort; n = 50) or conventional fluoroscopy (retrospective control cohort; n = 50) were compared. When applied by the senior operator, the SWEET-Cryo strategy significantly reduced the mean fluoroscopy time (FT) (2.6 ± 1.25 vs. 20.3 ± 10.8 min) and mean dose area product (DAP) (5.1 ± 3.8 vs. 35.3 ± 22.3 Gy cm2) compared with those of the control group, respectively (P < 0.001). Significant reductions in FT (6.4 ± 2.5 min vs. 32.5 ± 10.05) and DAP (13.9 ± 7.7 vs. 92.3 ± 63.8) were also achieved by the less experienced operator (P < 0.001). No difference was observed in acute and long-term complications or freedom from AF between fluoroscopy strategies during a 33-month median follow-up. Mean FT was maintained below 3 min in randomly selected cases performed during the follow-up period. CONCLUSION In contrast to conventional protocols and regardless of the operator's experience, the optimized SWEET-Cryo strategy dramatically reduced fluoroscopy exposure during CB-PVI. The efficacy, safety, or added costs of the ablation procedure were not compromised.
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Affiliation(s)
- Daniel Rodríguez Muñoz
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Álvaro Marco del Castillo
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Ez Alddin Rajjoub Al-Mahdi
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Carla Lázaro Rivera
- Cardiology Department, Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040 Madrid, Spain
| | - María Guisasola Cienfuegos
- Cardiology Department, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain
| | - Javier Ramos Jiménez
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Luis Borrego Bernabé
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Fernando Arribas Ynsaurriaga
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
- Department of Medicine, Universidad Complutense, Av. Séneca, 2, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - Rafael Salguero-Bodes
- Cardiology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041 Madrid, Spain
- Department of Medicine, Universidad Complutense, Av. Séneca, 2, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de enfermedades CardioVasculares (CIBERCV), Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
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Velagic V, Mugnai G, Prepolec I, Pasara V, Puljevic M, Pezo-Nikolic B, Puljević D, de Asmundis C, Chierchia GB, Milicic D. Radiation dose reduction in the setting of cryoballoon ablation for atrial fibrillation: the value of optimized fluoroscopy settings and intracardiac echocardiography. Int J Cardiovasc Imaging 2023; 39:245-254. [PMID: 36598699 DOI: 10.1007/s10554-022-02717-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/10/2022] [Indexed: 01/11/2023]
Abstract
Cryoballoon (CB) has proven to be very effective in the percutaneous treatment of atrial fibrillation (AF). CB ablation is still hampered by X-ray exposure and the doses applied are consistently higher if compared to radiofrequency ablation. All patients who underwent CB ablation between 2015 and 2020 were analysed. Intracardiac echography was consistently used for transeptal puncture. To demonstrate the differences in radiation exposure 3 groups of 50 consecutive patients were selected. In the first group (G1) 3D rotational angiography (3DRA) was used as an intraprocedural imaging method. In the second group (G2), traditional X-ray imaging was used and frame rates both for fluoro and cine modes of diascopy were lowered. In the third group (G3) only 2-3 frames per second were used, cine mode was abandoned and the grid was removed from the X-ray detector. A total of 150 patients were included (76% males, mean age 57.3 ± 11.5 years). A dramatic reduction of radiation dose was obtained from 9585 ± 5610 µGy/m2 in G1 to 2469 ± 2002 µGy/m2 in G2 and finally 227.1 ± 360 µGy/m2 in G3 (p < 0.0001). There was also a significant decrease of procedural and fluoroscopy times. No difference in major complications and midterm outcomes was found between the groups. By following a few relatively simple steps (omitting the pre-procedural imaging, removing grid from the X-ray detector and using very low frame rates) CB ablation could be performed with ultralow radiation exposure without compromising the safety of efficacy of the procedure.
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Affiliation(s)
- Vedran Velagic
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Giacomo Mugnai
- Electrophysiology and Cardiac Pacing, Division of Cardiology, University Hospital of Verona, Verona, Italy
| | - Ivan Prepolec
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Vedran Pasara
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Mislav Puljevic
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Borka Pezo-Nikolic
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Davor Puljević
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia
| | | | | | - Davor Milicic
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000, Zagreb, Croatia
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Heinroth K, Blum T, Drexler M, Plehn A, Hartkopf T, Horenburg C, Sedding D. X-ray exposure in cryoballoon versus radiofrequency ablation for atrial fibrillation over 7 years: A single center study. J Arrhythm 2022; 38:1017-1027. [PMID: 36524039 PMCID: PMC9745457 DOI: 10.1002/joa3.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/09/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
Background Facing an increasing number of radiofrequency ablation (RF) and cryoballoon ablation (CB) procedures for treatment of AF radiation exposure and its reduction is a focus point for interventional electrophysiologists. Objective This study evaluated the procedural parameters of the different ablation methods focusing on radiation exposure and the BMI of the patients. Methods One thousand one hundred and thirty-three first procedural cases of pulmonary vein isolation in patients with paroxysmal and persistent AF treated with RF and CB-based techniques were analyzed retrospectively over a period of 7 years focusing on the endpoints dose area product (DAP, cGycm2), fluoroscopy time (FT, min) and procedural time (PT, min). Results Of the 1133 patients (mean age 63.4 ± 11.4 years, BMI 28.9 ± 4.7) 335 patients received an RF procedure, 211 patients were treated with the cryoballoon first generation (CB1), and 587 patients with cryoballoon second generation (CB2), respectively. The mean DAP for the PVI was 508 ± 654 cGycm2 in RF procedures, 1077 ± 683 cGycm2 in CB1-procedures, and 587 ± 489 cGycm2 in CB2-procedures with fluoroscopy times significantly shorter in RF procedures (9.6 ± 5.2 min) as compared to 17.7 ± 5.9 min in CB1- and 16.3 ± 6.3 min in CB2-procedures (p < .001). At the same time, the procedure duration using RF (115 ± 33.5 min) was significantly longer than both in CB1 (96 ± 16.8 min) and CB2 procedures (75 ± 15.9 min). Conclusions Despite longer fluoroscopy durations in the CB technique, the CB2 resulted in a comparable low radiation exposure in PVI as compared to RF, accompanied by shorter procedure durations.
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Affiliation(s)
- Konstantin Heinroth
- Department of Medicine IIIMartin‐Luther‐University Halle‐WittenbergHalleGermany
- Department of Medicine IMartha‐Maria DoelauHalleGermany
| | - Tilman Blum
- Department of Medicine IIIMartin‐Luther‐University Halle‐WittenbergHalleGermany
| | - Max Drexler
- Department of Medicine IIIMartin‐Luther‐University Halle‐WittenbergHalleGermany
| | - Alexander Plehn
- Department of Medicine IIIMartin‐Luther‐University Halle‐WittenbergHalleGermany
| | - Thomas Hartkopf
- Department of Medicine IIIMartin‐Luther‐University Halle‐WittenbergHalleGermany
| | - Charlotte Horenburg
- Department of Medicine IIIMartin‐Luther‐University Halle‐WittenbergHalleGermany
- Department of Medicine IMartha‐Maria DoelauHalleGermany
| | - Daniel Sedding
- Department of Medicine IIIMartin‐Luther‐University Halle‐WittenbergHalleGermany
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