Impact of obesity and prognostic nutritional index on outcomes of ventricular tachycardia ablation in patients with structural heart disease

Abstract

Objectives: Previous studies have demonstrated that nutritional disorders such as obesity and malnutrition are associated with adverse events in patients with a structural heart disease. The impact of these conditions in patients undergoing ventricular tachycardia (VT) ablation is not known. In this study we sought to investigate the effect of obesity and malnutrition on procedural and post-procedural midterm outcomes in patients undergoing VT ablation. Materials and methods: This is a single center, retrospective study which enrolled patients undergoing structural VT ablation. Patients were classified as normal weight, overweight and obese by body mass index (BMI). Malnutrition was defined as prognostic nutritional score (PNI) < 38. Outcomes between groups were compared. Results: A total of 203 patients were enrolled to this study. Among these patients, 54 (25.6%) were normal weight, 102 patients (50.2%) were overweight, and 47 patients (23.1%) were obese. 18 patients (8.8%) were classified as malnourished. No significant difference in VT recurrence was observed across BMI (p=0.335) or nutritional status (p=0.556). However, mortality during follow-up was significantly higher in the malnourished group (50% vs. 7%, p<0.001), while BMI showed no significant association with mortality (p=0.202). On multivariate analysis, only PNI <38 (HR 6.659, 95% CI 2.553–17.369, p<0.001) and electrical storm (HR 2.848, 95% CI 1.133–7.160, p=0.026) remained independent predictors of mortality. Conclusion: This study demonstrated that malnourished patients, as classified by PNI, had significantly worse acute success and higher long-term mortality with similar VT recurrence rate, compared to non-malnourished patients. Obesity status, as defined by BMI, did not lead to different outcomes.

Keywords

• catheter ablation
• heart failure
• malnutrition
• obesity
• ventricular tachycardia

Yapısal Kalp Hastalığı Olan Hastalarda Ventriküler Taşikardi Ablasyonunun Sonuçları Üzerinde Obezite ve Prognostik Beslenme İndeksinin Etkisi

Abstract

Amaç: Önceki çalışmalar, obezite ve malnütrisyon gibi beslenme bozukluklarının yapısal kalp hastalığı olan hastalarda olumsuz sonuçlarla ilişkili olduğunu göstermiştir. Bu durumların ventriküler taşikardi (VT) ablasyonu geçiren hastalardaki etkisi ise bilinmemektedir. Bu çalışmada, VT ablasyonu geçiren hastalarda obezite ve malnütrisyonun işlem sırasındaki ve işlem sonrası orta vadeli sonuçlar üzerindeki etkisini araştırmayı amaçladık. Gereç ve yöntem: Bu tek merkezli, retrospektif çalışmaya yapısal VT ablasyonu uygulanan hastalar dahil edilmiştir. Hastalar beden kitle indeksi (BKİ) kullanılarak normal kilolu, fazla kilolu ve obez olarak sınıflandırılmıştır. Malnütrisyon, prognostik beslenme indeksi (PNI) < 38 olarak tanımlanmıştır. Gruplar arasındaki sonuçlar karşılaştırılmıştır. Bulgular: Çalışmaya toplam 203 hasta dahil edilmiştir. Bu hastaların 54’ü (%25,6) normal kilolu, 102’si (%50,2) fazla kilolu ve 47’si (%23,1) obez olarak sınıflandırılmıştır. Öte yandan, 18 hasta (%8,8) malnütrisyonlu olarak tanımlanmıştır. BKİ (p=0,335) veya beslenme durumu (p=0,556) ile VT nüksü arasında anlamlı bir ilişki gözlemlenmemiştir. Ancak takip sürecinde mortalite, malnütrisyonlu grupta anlamlı şekilde daha yüksek bulunmuştur (%50 ve %7, p<0,001); buna karşın BKİ ile mortalite arasında anlamlı bir ilişki saptanmamıştır (p=0,202). Çok değişkenli analizde, yalnızca PNI <38 (HR 6,659, %95 GA 2,553–17,369, p<0,001) ve elektriksel fırtına (HR 2,848, %95 GA 1,133–7,160, p=0,026) mortalitenin bağımsız belirleyicileri olduğu saptanmıştır. Sonuç: Bu çalışma, PNI ile malnütrisyonlu olarak sınıflandırılan hastaların, malnütrisyonlu olmayan hastalara kıyasla benzer VT nüks oranına rağmen anlamlı şekilde daha düşük akut başarı ve daha yüksek uzun vadeli mortaliteye sahip olduğunu göstermiştir. BKİ ile tanımlanan obezite durumu ise sonlanım noktalarında farklılığa yol açmamıştır.

Keywords

• kateter ablasyon
• kalp yetersizliği
• malnutrisyon
• obezite
• ventriküler taşikardi

References

1. Tan NY, Roger VL, Killian JM, et al. Ventricular Arrhythmias Among Patients With Advanced Heart Failure: A Population‐Based Study. J Am Heart Assoc. 2022;11(1):e023377.
2. Della Bella P, Baratto F, Vergara P, et al. Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator? Results From the Multicenter Randomized PARTITA Trial. Circulation. 2022;145(25):1829–38.
3. Tung R, Xue Y, Chen M, et al. First-Line Catheter Ablation of Monomorphic Ventricular Tachycardia in Cardiomyopathy Concurrent With Defibrillator Implantation: The PAUSE-SCD Randomized Trial. Circulation. 2022;145(25):1839–49.
4. Esteban-Fernández A, Villar-Taibo R, Alejo M, et al. Diagnosis and Management of Malnutrition in Patients with Heart Failure. J Clin Med. 2023;12(9):3320.
5. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021;143(21):e984-e1010.
6. Messerli FH. Overweight and sudden death. Increased ventricular ectopy in cardiopathy of obesity. Arch Intern Med. 1987;147(10):1725–8.
7. Adabag S, Huxley RR, Lopez FL, et al. Obesity related risk of sudden cardiac death in the atherosclerosis risk in communities study. Heart. 2015;101(3):215–21.
8. Tan MC, Yeo YH, Ang QX, et al. Impact of obesity on catheter ablation of ventricular tachycardia: In-hospital and 30-day outcomes. J Arrhythm. 2023;39(4):672–5.

9. Wattanachayakul P, Srikulmontri T, Prasitsumrit V, et al. Malnutrition and risks of atrial fibrillation recurrence after catheter ablation. J Arrhythm. 2025;41(1):e13196.
10. Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022;43(40):3997–4126.
11. Raposeiras Roubín S, Abu Assi E, Cespón Fernandez M, et al. Prevalence and Prognostic Significance of Malnutrition in Patients With Acute Coronary Syndrome. J Am Coll Cardiol. 2020;76(7):828–40.
12. Baskovski E, Altin T, Akyurek O, et al. Fascicular/Purkinje Tissue Colocalized With Scar in Cardiomyopathy Patients Undergoing Ventricular Fibrillation Ablation. Pacing Clin Electrophysiol. 2025;48(7):672-681.
13. Baskovski E, Altin T, Akyurek O, et al. Contemporary outcomes of catheter ablation of the structural ventricular tachycardias in severe ischemic and non‐ischemic cardiomyopathies in Turkish population. J Arrhythm. 2024;40(6):1425–31.
14. Tabaja C, Younis A, Santageli P, et al. Impact of obesity on catheter ablation of atrial fibrillation: Patient characteristics, procedural complications, outcomes, and quality of life. J Cardiovasc Electrophysiol. 2023;34(8):1648–57.
15. Cox N, Resnic FS, Popma JJ, et al. Comparison of the risk of vascular complications associated with femoral and radial access coronary catheterization procedures in obese versus nonobese patients. Am J Cardiol. 2004;94(9):1174–7.
16. Winkle RA, Mead RH, Engel G, et al. Impact of obesity on atrial fibrillation ablation: Patient characteristics, long-term outcomes, and complications. Heart Rhythm. 2017;14(6):819–27.
17. Kim D, Shim J, Kim YG, et al. Malnutrition and Risk of Procedural Complications in Patients With Atrial Fibrillation Undergoing Catheter Ablation. Front Cardiovasc Med. 2021;8:736042.
18. Pagnesi M, Serafini L, Chiarito M, et al. Impact of malnutrition in patients with severe heart failure. Eur J Heart Fail. 2024;26(7):1585–93.
19. Darma A, Bertagnolli L, Dinov B, et al. Predictors of long-term mortality after catheter ablation of ventricular tachycardia in a contemporary cohort of patients with structural heart disease. EP Europace. 2020;22(11):1672–9.
20. Muser D, Castro SA, Liang JJ, Santangeli P. Identifying Risk and Management of Acute Haemodynamic Decompensation During Catheter Ablation of Ventricular Tachycardia. Arrhythm Electrophysiol Rev. 2018;7(4):1.
21. Collamati A, Marzetti E, Calvani R, et al. Sarcopenia in heart failure: mechanisms and therapeutic strategies. J Geriatr Cardiol. 2016;13(7):615–24.
22. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31.