Effects of obesity on arrhythmic events and survival in patients with an implantable cardioverter defibrillator

Background    Studies have shown that increased body weight and obesity may be associated with an increased risk of arrhythmic events. The aim of this study was to evaluate the effect of obesity on the risk of arrhythmic events, hospitalization, and death in patients who received implantable cardioverter defibrillator (ICD) therapy for primary or secondary prevention.
Material and Methods    A single-center, prospective, observational study was conducted. Patients with body mass index (BMI) <30 kg / m2 were classified as non-obese, and patients with BMI ≥30 kg / m2 were classified as obese. The primary endpoints were arrhythmic events and device interventions. The secondary endpoints were all-cause mortality, cardiac mortality, cardiac rehospitalization, and a composite endpoint of mortality and hospitalization.
Results    Among a total of 340 patients, 78.2 % were male, and 22.1 % were obese. The mean age was 60.9 yrs. Ventricular tachycardia (VT) was more frequent in non-obese patients (HR 0.57, [CI] 0.38–0.87, p=0.009). All-cause mortality and cardiac mortality in all patients tended to be more frequent in non-obese (HR 2.71, [CI] 0.93–7.93, p= 0.069 for all-cause mortality; HR 3.29, [CI] 0.97–11.17, p=0.056 for cardiac mortality). In the subgroup analysis, VT, all-cause mortality, and cardiac mortality were more common for non-obese patients in primary prevention and ischemic heart failure (HF) groups.
Conclusion    While VT was more frequent in non-obese patients, VF, ICD appropriate shock, inappropriate shock, and antitachycardia pacing were similar in obese and non-obese patients. All-cause mortality and cardiac mortality were more frequent in non-obese patients.

1. Samanta R, Narayan A, Pouliopoulos J, Kovoor P, Thiagalingam A. Influence of Body Mass Index on Recurrence of Ventricular Arrhythmia, Mortality in Defibrillator Recipients With Ischaemic Cardiomyopathy. Heart, Lung and Circulation. 2020;29(2):254–61. DOI: 10.1016/j.hlc.2018.12.018

2. Zhou B, Zhao S, Tang M, Chen K, Hua W, Su Y et al. Overweight and obesity as protective factors against mortality in nonischemic cardiomyopathy patients with an implantable cardioverter defibrillator. Clinical Cardiology. 2020;43(12):1435–42. DOI: 10.1002/clc.23458

3. Kannel WB, Wilson PWF, Nam B-H, D’Agostino RB. Risk stratification of obesity as a coronary risk factor. The American Journal of Cardiology. 2002;90(7):697–701. DOI: 10.1016/s0002-9149(02)02592-4

4. Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah AS, Habib RH. Obesity and risk of new-onset atrial fibrillation after cardiac surgery. Circulation. 2005;112(21):3247–55. DOI: 10.1161/CIRCULATIONAHA.105.553743

5. Wang TJ, Parise H, Levy D, D’Agostino RB, Wolf PA, Vasan RS et al. Obesity and the Risk of New-Onset Atrial Fibrillation. JAMA. 2004;292(20):2471–7. DOI: 10.1001/jama.292.20.2471

6. McDonagh TA, Morrison CE, Lawrence A, Ford I, Tunstall-Pedoe H, McMurray JJ et al. Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population. The Lancet. 1997;350(9081):829–33. DOI: 10.1016/S0140-6736(97)03033-X

7. Choy B, Hansen E, Moss AJ, McNitt S, Zareba W, Goldenberg I. Relation of Body Mass Index to Sudden Cardiac Death and the Benefit of Implantable Cardioverter–Defibrillator in Patients With Left Ventricular Dysfunction After Healing of Myocardial Infarction. The American Journal of Cardiology. 2010;105(5):581–6. DOI: 10.1016/j.amjcard.2009.10.041

8. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2016;37(27):2129–200. DOI: 10.1093/eurheartj/ehw128

9. Stein KM, Mittal S, Gilliam FR, Gilligan DM, Zhong Q, Kraus SM et al. Predictors of early mortality in implantable cardioverter-defibrillator recipients. Europace. 2009;11(6):734–40. DOI: 10.1093/europace/eup055

10. González-Cambeiro MC, Rodríguez-Mañero M, Abellas-Sequeiros A, Moreno-Arribas J, Filgueira-Rama D, González-Juanatey JR. Prognostic Effect of Body Mass Index in Patients With an Implantable Cardioverter-defibrillator for Primary Prevention of Sudden Death. Revista Española de Cardiología (English Edition). 2016;69(10):990–2. DOI: 10.1016/j.rec.2016.04.055

11. Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA. Body mass index and mortality in heart failure: a meta-analysis. American Heart Journal. 2008;156(1):13–22. DOI: 10.1016/j.ahj.2008.02.014

12. Pietrasik G, Goldenberg I, McNITT S, Moss AJ, Zareba W. Obesity As a Risk Factor for Sustained Ventricular Tachyarrhythmias in MADIT II Patients. Journal of Cardiovascular Electrophysiology. 2007;18(2):181–4. DOI: 10.1111/j.1540-8167.2006.00680.x

13. Carbone S, Canada JM, Billingsley HE, Siddiqui MS, Elagizi A, Lavie CJ. Obesity paradox in cardiovascular disease: where do we stand? Vascular Health and Risk Management. 2019;15:89–100. DOI: 10.2147/VHRM.S168946

14. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories: A Systematic Review and Meta-analysis. JAMA. 2013;309(1):71–82. DOI: 10.1001/jama.2012.113905

15. Carnethon MR, De Chavez PJD, Biggs ML, Lewis CE, Pankow JS, Bertoni AG et al. Association of weight status with mortality in adults with incident diabetes. JAMA. 2012;308(6):581–90. DOI: 10.1001/jama.2012.9282