Morbid obesity tied to risk for complications in LAA closure
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In patients with atrial fibrillation who underwent percutaneous left atrial appendage closure for stroke prevention, morbid obesity was associated with higher odds of complications and longer length of stay, researchers reported.
However, nonmorbid obesity was associated with lower odds of overall complications and major complications compared with nonobesity, according to the study published in HeartRhythm.
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Siddharth Agarwal, MD, an internal medicine resident at University of Oklahoma Health Sciences Center, and colleagues analyzed 62,980 patients included in the National Inpatient Sample who underwent percutaneous left atrial appendage (LAA) closure between 2015 and 2019. During the study period, the only percutaneous LAA occlusion device approved by the FDA was the Watchman (Boston Scientific).
Among the cohort, 6.7% had morbid obesity, defined as BMI of 40 kg/m2 or more (mean age, 71 years; 53% women), 10.3% had obesity, defined as BMI of 30 kg/m2 to less than 40 kg/m2 (mean age, 74 years; 38% women), and the remainder were without obesity, defined as BMI less than 30 kg/m2 (mean age, 77 years; 41% women).
The rates of overall complications were 13.8% in patients with morbid obesity, 8% in patients with obesity and 9.8% in patients without obesity, whereas the rates of major complications were 8.1% in patients with morbid obesity, 4.5% in patients with obesity and 6.1% in patients without obesity (P < .01 for both), Agarwal and colleagues wrote.
After adjustment for age, sex, race and underlying comorbidities, morbid obesity was independently associated with greater odds of overall complications (adjusted OR = 1.33; 95% CI, 1.06-1.65; P < .01) and length of stay for more than 1 day (aOR = 3.39; 95% CI, 1.95-5.9; P < .01) compared with nonobesity, according to the researchers.
However, obesity was associated with lower odds of overall complications (aOR = 0.73; 95% CI, 0.58-0.91; P < .01) and major complications (aOR = 0.72; 95% CI, 0.54-0.95; P = .02) but greater odds of length of stay for more than 1 day (aOR = 2.36; 95% CI, 1.38-4.04; P < .01) compared with nonobesity, the researchers wrote.
“Our study is the first to demonstrate that obese patients undergoing LAA occlusion implantation had a significantly lower prevalence of overall and major complications as compared to nonobese patients despite having a higher burden of other comorbidities,” Agarwal and colleagues wrote. “In our study, morbidly obese patients had significantly higher adjusted odds of overall complications as compared to nonobese patients. Our findings are consistent with other studies [that] have demonstrated a U-shaped effect with BMI on the incidence of complications in patients undergoing PCI and AF ablations, such that complications increase in underweight patients but paradoxically decrease in patients with mild to moderate obesity before increasing again in patients with morbid obesity.”
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