Ablation for Permanent Atrial Fibrillation: Metabolic Impact of Obesity-Associated Signals

Objectives: Higher risks of bleeding, stroke, remodeling, cardiac dysfunction, and reduced survival are a consequence of permanent atrial fibrillation (AF) acceptance. Concomitant ablation can reach freedom from AF (FREEAF). However, adipocytokines affect atrial fibrosis and thus initiation and progression of AF.

Methods: Ablation-naive, cardiologist-defined permanent AF patients underwent cardiac surgery and concomitant ablation, loop recorder implantation. Follow-up was performed over 2 years. Influence of obesity and obesity associated signaling (NCRNA/RNA/protein) was analyzed.

Result: 86% parAF and 70% formerly accepted permanent AF (FAP) patients reached FREEAF (month: 24). Mortality was low (parAF/FAP: 5.3 ± 0.2%/4.1 ± 0.3%; p < 0.05; EuroSCORE II; 6.1 ± 0.7%; 6.4 ± 0.4%) and no strokes occurred. FREEAF improved atrial re-remodeling and cardiac function (LA diameter (−6.7 ± 2.2 mm)/LVEF (+7.3 ± 2.8%)). Increased BMI perpetuated AF. Adiponectin was higher in parAF (15.9 ± 1.6 vs. 10.7 ± 1.1 µg/mL, p < 0.01). TGF-β superfamily members activin A (175.9 ± 21.1 vs. 269.5 ± 32.1 pg/mL, p < 0.05) and TGF-β1 (17.9 ± 1.8 vs. 25.9 ± 3.3 ng/mL, p < 0.05), showed higher levels in FAP.

Conclusion: Long-term SR is reachable by concomitant ablation therapy even in FAP patients and should therefore be offered also to those. Cardiometabolic efforts can modulate structural and electrical remodeling and may improve rates of freedom from atrial fibrillation.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021