https://digitalcommons.unmc.edu/surp2022/1018/thumbnail.jp

Aguto, James

Almerstandi, Muaaz

Anderson, Daniel

Aroudaky, Ahmad

Dircks, Danielle

Easley, Arthur

Haynatzki, Gleb

Khaing, Eh M

Khan, Faris

Mimms, Jmaylia

Naksuk, Niyada

Payne, Jason

Schleifer, William

Tsai, Shane

Windle, John

English

University of Nebraska Medical Center Research: DigitalCommons@UNMC

University of Nebraska Medical Center DigitalCommons@UNMC Posters: 2022 Summer Undergraduate Research Program Summer Undergraduate Research Program Summer 8-10-2022 Representation and Outcome of Catheter Ablation for Treatment of Atrial Fibrillation Among Patients with Obesity: A Systematic Review of Randomized Control Studies Eh M. Khaing University of Nebraska at Omaha Danielle Dircks University of Nebraska Medical Center Ahmad Aroudaky University of Nebraska Medical Center Muaaz Almerstandi University of Nebraska Medical Center James Aguto University of Nebraska Medical Center See next page for additional authors Follow this and additional works at: https://digitalcommons.unmc.edu/surp2022 Recommended Citation Khaing, Eh M.; Dircks, Danielle; Aroudaky, Ahmad; Almerstandi, Muaaz; Aguto, James; Mimms, Jmaylia; Schleifer, William; Payne, Jason; Easley, Arthur; Khan, Faris; Windle, John; Tsai, Shane; Anderson, Daniel; Haynatzki, Gleb; and Naksuk, Niyada, "Representation and Outcome of Catheter Ablation for Treatment of Atrial Fibrillation Among Patients with Obesity: A Systematic Review of Randomized Control Studies" (2022). Posters: 2022 Summer Undergraduate Research Program. 16. https://digitalcommons.unmc.edu/surp2022/16 This Poster is brought to you for free and open access by the Summer Undergraduate Research Program at DigitalCommons@UNMC. It has been accepted for inclusion in Posters: 2022 Summer Undergraduate Research Program by an authorized administrator of DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. Author Eh M. Khaing, Danielle Dircks, Ahmad Aroudaky, Muaaz Almerstandi, James Aguto, Jmaylia Mimms, William Schleifer, Jason Payne, Arthur Easley, Faris Khan, John Windle, Shane Tsai, Daniel Anderson, Gleb Haynatzki, and Niyada Naksuk This poster is available at DigitalCommons@UNMC: https://digitalcommons.unmc.edu/surp2022/16 Representation and Outcome of Catheter Ablation for Treatment of Atrial FibrillationAmong Patients with Obesity: A Systematic Review of Randomized Control StudiesEh Khaing1, Danielle Dircks, BS2, Ahmad Aroudaky, MD3, Muaaz Almerstani, MD3, James Aguto, BS HCB HLA3, Jmaylia Mimms, CMA/NICT3, William Schleifer, MD3, Jason Payne, MD3, Arthur Easley, MD3, Faris Khan, MD, MS3, John Windle, MD3, Shane Tsai, MD, MBA3, Daniel Anderson, MD, PhD3, Gleb Haynatzki, PhD, DSc3,4, Niyada Naksuk, MD31University of Nebraska Omaha, 2College of Medicine, 3Division of Cardiovascular Medicine, 4Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska• Most catheter ablation of AF RCTs underreported the proportion of obese participants and its impact on the main outcomes.• Using available BMI data, we estimated ~ 39% of AF patients had concomitant obesity.• BMI/ body weight affected the main outcomes among 36% of these contemporary AF trials.• Our systematic review of AF RCTs confirmed that obesity is a common comorbidity among AF patients. However, enrollment of obese participants and its impact on results in AF RCTs are underreported.Relevance and Future Directions• Although some limited information regarding BMI of study participants were made available in AF trials, our present systematic review suggested that RCTs have continued to underreport such information.• A standardized system that encourages adequate representation of obese participants and transparency in reporting such information in AF research is needed to ensure applicability of results to obese patients with AF. Summer Undergraduate Research Program• The rapid rises in atrial fibrillation (AF) and obesity have been identified as global epidemics associated with increased mortality and morbidity.• Observational studies reported 18%-30% of concomitant obesity among AF patients.• Obesity is a known risk factor of AF incidence, progression, and recurrence after ablation.Objective: 1. Examine the proportion of patients with obesity represented in contemporary RCTs of catheter ablation for treatment of AF2. Examine potential risks associated with underrepresentation of obese participants3. Examine the impact of obesity on the main outcomes across RCTsBackground• We included 116 RCTs comprised of 25,219 participants. • 112 (96.6%) trials did not report the proportion of obese participants • 2 RCTs investigating cryoballoon ablation excluded BMI>35 kg/m2• 75 (64.7%) trials reported BMI of study participants.AuthoryearInterventions Primary Results Obesity, % Results of subgroup analysis for obesityEffects of BMI on resultsVerma2015PVI vs. PVI+ Fractionated Electrograms vs. PVI +Linear ablationNo difference in freedom from AF recurrenceNot reportedForest plot: In BMI≤29 kg/m2, PVI alone was better than PVI + lines. In BMI>29 mg/m2, no difference in freedom from AF recurrence.YesScherr2015Posterior vs. Anterol6ateral mitral isthmus ablationNo difference in bi-directional MI conduction block36%Obesity (BMI>30 kg/m2) had higher failure of MA block (64% vs. 25%; P=0.03).YesPrabhu2017Adenosine 12 mg vs. 18 mg vs. 24 mgHigher dose increased desirable effect (dormant conduction and atrioventricular block)Estimated 44.8%BW ≥90 kg had a significantly attenuated response. BW ≥110 kg had significantly reduced in desirable effect (atrioventricular block).YesKirchhof2020Early rhythm control vs. Usual careEarly rhythm control decreased CV mortality, stroke, HF/ACShospitalizationEstimated 37.1%Forest plot: BMI≥40 kg/m2 favored early rhythm control. However, early rhythm control did not benefit in other BMI groups.YesResultsMethodsFunding: The Jensen Family Research Funding, Division of Cardiovascular, UNMCDisclosures: None• We searched PubMed for RCTs examining management of AF mainly endocardial catheter ablation published between 01//01/2015 to 05/31/2022, Figure 1. • Among the RCTs that did not provide the actual proportion of obese participants and when data regarding body mass index (BMI) were available, normal distribution was assumed and a z-score was used to estimate the proportion of obese participants. • Obesity was defined as BMI>25 kg/m2 in RCTs conducted in Asia and >30 kg/m2 in RCTs conducted in other continents.  Figure 1. Diagram of RCT selection and inclusion processFigure 3. Estimated proportion of obese participants by regions of RCTs (P<0.001)Records from PubMed (N = 645)IdentificationScreeningEligibilityIncludedRecords screened by EK and DD (N = 649)Full-text articles assessed for eligibility(N = 136)Excluded(N = 20)RCTs included in analysis (N = 116)Additional records (N = 4)Excluded(N = 513)Reporting data regarding obesity and BMIEstimated representation of obese participantsSubgroup analysis of obese participants or analysis adjusting for BMI• Using BMI info, we estimated the proportion of obese participants varied greatly, ranging from 5.8% to 71.9% (median, 38.6%, IQR 28.8%, 50.0%) across AF RCTs. • The trends of providing the BMI information had improved over time (P=0.02), Figure 2A. • However, the proportion of obese participants continued to varied across the years, Figure 2B. ConclusionNorth America Asia Europe020406080Obese participants, %Additional analysis regarding BMI or body weight was conducted in 11 (9.5%) RCTs; 4 (36.4%) of these suggested that BMI or body weight affected their main findings. Representation of obese participants according to RCT characteristics• There was no evidence of difference in the proportion of obese participants between government-support trials vs. industrial-support trials or single-center vs. multi-center trials. • Study size or the registration record status was not associated with greater proportion of obese participants. • Representation of obese participants was higher in trials from North America (49.8%) and Asia (45.0%), as compared to Europe (31.3%), P<0.001, Figure 3. 4930215170790%25%50%75%100%2015-2016(N=39)2017-2018(N=30)2019-2022(N=47)RCTs, %Published YearNot report BMIReport BMIFigure 2. While the numbers of RCTs reporting obesity or BMI data improved over the years (P=0.02, 2A), the estimated proportion of obese participants remained varied and not improved, (2B)2015-2016 2017-2018 2019-2022020406080Published yearObese participants, %2A2B

Representation and Outcome of Catheter Ablation for Treatment of Atrial Fibrillation  Among Patients with Obesity: A Systematic Review of Randomized Control Studies

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Representation and Outcome of Catheter Ablation for Treatment of Atrial Fibrillation Among Patients with Obesity: A Systematic Review of Randomized Control Studies

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