Influència de l'índex de massa corporal en el restabliment i el manteniment del ritme sinusal en la fibril·lació auricular persistent

Identificador:  TDX:4541

Handle: https://hdl.handle.net/20.500.11797/TDX4541

Autors:  Ligero Ferrer, Maria Carmen

Resum:
Background: Body mass index (BMI) has been associated with the incidence of atrial fibrillation (AF), but its impact on AF recurrence post-electrical cardioversion (EC) and the cardioversion efficacy of amiodarone in restoring sinus rhythm (SR) is not clear. Methods: We examined 1121 patients included in three Spanish EC registries for persistent AF to determine the effect of BMI on AF recurrence post-EC and 878 patients included in two of these registries to evaluate the influence of BMI on the cardioversion efficacy of amiodarone. Results: Regarding AF recurrence, 48% of patients experienced recurrence within 3 months post-EC, associated with a higher BMI (29.66±4.57 vs. 28.87±4.64 kg/m²; p=0.004). Patients with overweight/obesity had higher recurrence rates (50.5% vs. 35.6%; p<0.001), with a BMI ≥25 kg/m² being an independent predictor of recurrence (OR=1.75; p=0.004). We observed progressively higher frequencies of recurrence in the overweight and obesity categories (normal weight 35.6%, overweight 49.1%, obesity 52.1%; p=0.001; normal weight vs. overweight p=0.001; normal weight vs. obesity p<0.001). Of the patients treated with amiodarone, 21.1% reverted to SR before EC. A higher BMI was associated with a lower percentage of reversion (normal weight 28.3%, overweight 21.3%, obesity 13.1%; p<0.001), with BMI remaining in the multivariable analysis as an independent variable inversely related to reversion to SR (OR=0.904 × kg/m²; p<0.001). Conclusions: Elevated BMI is independently associated with a higher recurrence of AF after EC and a lower cardioversion efficacy of amiodarone, highlighting the negative impact of overweight and obesity on the rhythm control strategy of AF.