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

Abstract

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.

Keywords

• 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

Abstract

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.

Keywords

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

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