Increased Body Mass Index is Associated with Device Detected Silent Atrial Fibrillation

Yıl 2018, Cilt: 21 Sayı: 3, 230 - 235, 02.12.2018

Emrah Bozbeyoğlu Göksel Çinier

Öz

Introduction:
Atrial fibrillation (AF) is the
most common cardiac rhythm disturbance in clinical practice. To prevent adverse
outcomes associated with AF, it is necessary to identify and manage the
modifiable risk factors. An increased body mass index (BMI) is strongly associated
with the incidence of clinically symptomatic AF. However, the association of
increased BMI with asymptomatic AF is unknown.

Patients
and Methods: We prospectively
evaluated 449 patients implanted with dual chamber pacemaker. Patients were
divided into 3 groups according to their baseline BMI (normal weight: BMI 18-25
kg/m², overweight: BMI 25-30 kg/m², and obesity: BMI >
30 kg/m²). Six months after the device implantation, pacemakers were
interrogated to identify atrial high rate episodes (AHREs), which were defined
as episodes faster than 220 bpm and longer than 5 minutes.

Results:
AHRE was
detected in 128 (28.5%) patients. Patients in the AHRE (+) group were older
(65.51 ± 8.99 years vs. 70.84 ± 8.05 years, p< 0.01) and had greater BMI
(26.84 ± 3.41 kg/m² vs. 28.65 ± 3.75 kg/m², p< 0.01) compared to those in the AHRE
(-) group. Patients in the AHRE (+) group had significantly higher mean resting
heart rate (84.03 ± 7.80 bpm vs. 74.76 ± 6.40 bpm, p< 0.01), greater left
atrium antero-posterior (LA-AP) diameter (4.14 ± 0.33 cm vs. 3.90 ± 0.31 cm,
p< 0.01), left atrium volume (31.92 ± 3.17 vs. 30.38 ± 3.15, p< 0.01),
and CHA2DS2-VASc score (2.29 ± 0.83 vs. 1.81 ± 0.76, p< 0.01). On
multivariate analysis, increased BMI, age, mean resting heart rate, LA-AP
diameter, and CHA2DS2-VASc score were independently associated with the
incidence of AHRE.

Conclusion:
Increased
BMI is not only associated with symptomatic AF but also with asymptomatic AF
detected by cardiac implantable electronic devices.

Anahtar Kelimeler

Silent atrial fibrillation, asymptomatic atrial fibrillation, atrial high rate episodes, obesity, increased body mass index

Artmış Vücut Kitle İndeksi Cihaz ile Saptanan Sessiz Atriyal Fibrilasyon Atakları ile İlişkilidir

Öz

Giriş: Atriyal fibrilasyon (AF) klinikte en sık karşılaşılan
ritm bozukluğudur. AF ile ilişkili modifiye edilebilen risk faktörlerinin
tedavi edilmesi AF’ye bağlı iskemik inme gibi katastrofik sonuçları
engelleyebilmektedir. Artmış vücut kitle indeksi (VKİ) semptomatik AF atakları
ile ilişkilendirilmiştir. Ancak VKİ ile asemptomatik AF arasındaki ilişki henüz
ortaya çıkarılmamıştır.

Hastalar ve
Yöntem: Daha önce çift odacıklı pacemaker takılmış 449
hasta çalışmaya dahil edilmiştir. Hastalar VKİ değerlerine göre üç gruba ayrılmıştır
(normal VKİ: VKİ 18-25 kg/m², kilolu: VKİ 25-30 kg/m² ve obez: VKİ > 30 kg/m²). Cihaz implantasyonundan 6 ay sonra yapılan kontrolde
sessiz AF atakları yerine geçen atriyal yüksek hız epizodları (AYHE) tarandı.
AYHE 5 dakikadan uzun ve 220/dakika’dan uzun epizodlar olarak tanımlandı.

Bulgular: Cihaz kontrolleri sonunda hastaların 128 (28.5%)’inde
AYHE saptandı. AYHE (+) hastalar AYHE (-) hastalara göre daha yaşlı (65.51 ±
8.99 vs. 70.84 ± 8.05 p< 0.01) ve daha yüksek VKİ’ye (26.84 ± 3.41 kg/m²  vs. 28.65 ± 3.75 kg/m² p< 0.01) sahip bulundu. AYHE (+)
hastaların istirahat kalp hızları (84.03 ± 7.80 vs. 74.76 ± 6.40 vs. p<
0.01), sol atriyum antero-posterior çapları (LA-AP) (4.14 ± 0.33 vs. 3.90 ±
0.31, p< 0.01), sol atriyum volümleri (LAV) (31.92 ± 3.17 vs. 30.38 ± 3.15,
p< 0.01) ve CHA2DS2-VASc skorları (2.29 ±
0.83 vs. 1.81 ± 0.76, p< 0.01) AYHE (-) hastalara göre daha yüksek bulundu.
Yapılan çok değişkenli analizde artmış VKİ, istirahat kalp hızı, LA-AP ve CHA2DS2-VASc skorunun bağımsız
olarak AYHE prediktörleri olduğu gösterildi.

Sonuç: Artmış VKİ sadece semptomatik AF ile değil aynı zamanda cihaz tarafından
saptanan sessiz AF epizodları ile ilişkilidir.

Anahtar Kelimeler

Sessiz atriyal fibrilasyon, aseptomatik atriyal fibrilasyon, atriyal yüksek hız epizodları, obezite, artmış vücut kitle indeksi

Kaynakça

• 1. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text. Europace 2006;8:651-745.
• 2. Sposato LA, Cipriano LE, Saposnik G, Vargas ER, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol 2015;14:377-87.
• 3. Glotzer TV, Hellkamp AS, Zimmerman J, Sweeney MO, Yee R, Marinchak R, et al. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST). Circulation 2003;107:1614-9.
• 4. Gonzalez M, Keating RJ, Markowitz SM, Liu CF, Thomas G, Ip JE, et al. Newly detected atrial high rate episodes predict long-term mortality outcomes in patients with permanent pacemakers. Heart Rhythm 2014;11:2214-21.
• 5. Healey JS, Connolly SJ, Gold MR, Israel CW, Van Gelder IC, Capucci A, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med 2012;366:120-9.
• 6. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESCEndorsed by the European Stroke Organisation (ESO). Eur J Cardiothorac Surg 2016:ezw313.
• 7. Wang TJ, Parise H, Levy D, D’Agostino RB, Wolf PA, Vasan RS, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA 2004;292:2471-7.
• 8. Tedrow UB, Conen D, Ridker PM, Cook NR, Koplan BA, Manson JE, et al. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women’s health study). J Am Coll Cardiol 2010;55:2319-27.
• 9. Pathak RK, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Wong CX, et al. Long-term effect of goal-directed weight management in an atrial fibrillation cohort: A Long-Term Follow-Up Study (LEGACY). J Am Coll Cardiol 2015;65:2159-69.
• 10. Pi-Sunyer FX, Becker DM, Bouchard C, Carleton R, Colditz G, Dietz W, et al. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Am J Clin Nutr 1998;68:899-917.
• 11. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39. e14.
• 12. Jorgensen H, Nakayama H, Reith J, Raaschou H, Olsen TS. Stroke recurrence: predictors, severity, and prognosis. The Copenhagen Stroke Study. Neurology 1997;48:891-5.
• 13. Page RL, Wilkinson WE, Clair WK, McCarthy EA, Pritchett E. Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. Circulation 1994;89:224-7.
• 14. Tsang TS, Barnes ME, Miyasaka Y, Cha SS, Bailey KR, Verzosa GC, et al. Obesity as a risk factor for the progression of paroxysmal to permanent atrial fibrillation: a longitudinal cohort study of 21 years. Eur Heart J 2008;29:2227-33.
• 15. Pathak RK, Elliott A, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, et al. Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation: The CARDIO-FIT Study. J Am Coll Cardiol 2015;66:985-96.
• 16. Pathak RK, Middeldorp ME, Lau DH, Mehta AB, Mahajan R, Twomey D, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol 2014;64:2222-31.
• 17. Abed HS, Wittert GA, Leong DP, Shirazi MG, Bahrami B, Middeldorp ME, 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;310:2050-60.
• 18. Palatini P, Julius S. The physiological determinants and risk correlations of elevated heart rate. Am J Hypertens 1999;12:3S-8S.
• 19. Okin PM, Wachtell K, Kjeldsen SE, Julius S, Lindholm LH, Dahlof B, et al. Incidence of atrial fibrillation in relation to changing heart rate over time in hypertensive patients: the LIFE study. Circ Arrhythm Electrophysiol 2008;1:337-43.