Overweight Patients With Paroxysmal Atrial Fibrillation Might Benefit From Induction Strategies After Pulmonary Vein Isolation

Background:Strategies of adenosine triphosphate (ATP)-induction or reassessment at 30 minutes after pulmonary veins isolation (PVI) were both proved effective in revealing dormant reconnection and reducing recurrence. Overweight and obesity has been recently proved as a risk factor for new-onset atrial fibrillation.Objective:The aim of this study was to verify, on long-term follow-up, whether induction strategies have different influence on the long-term outcomes of paroxysmal atrial fibrillation patients with different Body Mass Index (BMI).Methods and results:The long-term follow-up data of 85 PAF patients receiving ablation followed by ATP-induction combined with reassessment at 30 minutes (group 1) were compared with those of 61 patients receiving traditional PVI strategy (group 2). After 12 months of follow-up, group 1 had fewer patients with recurrent AF (Kaplan-Meier analysis,87.2% VS 73.6%, P=0.04). The Kaplan-Meier analysis of time to first recurrence during the follow-up period (median time,521.3days) also showed that patients in group 1 had a greater probability of remaining free of AF (P=0.004). In a multivariate analysis, overweight with BMI≥24Kg/m2 (P=0.002) was an independent predictor of AF recurrence. The effects of the combined strategies in overweight patients and lean patients were then assessed respectively. We find an improvement in success rate only in patients with BMI＞24 Kg/m2(P=0.007) rather than patients with BMI＜24 Kg/m2(P=0.355).Conclusion:ATP-induction combined with reassessment at 30 minutes postisolation can significantly improve long-term success rate in PAF patients. And the effect might only play an important role in patients with BMI≥24 Kg/m2.