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

Year 2018, Volume: 21 Issue: 3, 230 - 235, 02.12.2018

Emrah Bozbeyoğlu Göksel Çinier

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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