De novo pulmonary vein isolation in obese vs nonobese patients under deep sedation: Does obesity increase procedure complexity?

Background Pulmonary vein isolation (PVI) in obese patients under deep sedation (DS) is anticipated to be more complex owing to challenging airway and hemodynamic management and dose adjustment of sedation drugs. Objective This study aimed to compare the complexity of de novo PVI in obese vs nonobese patients, with a particular focus on periprocedural sedation. Methods All patients undergoing de novo PVI under DS between January 2022 and January 2024 in our center were prospectively included. Data on detailed monitoring of respiratory and hemodynamic parameters during the procedure were collected. Two groups were defined (group 1, body mass index [BMI] of ≥30 kg/m 2 ; group 2, BMI of <30 kg/m 2 ) and compared in terms of DS tolerance, safety, and procedural success. Results Overall, 381 patients were included (61% male, median age 69 years); 120 were assigned to group 1 (BMI of 33 kg/m 2 [32–38]) and 261 to group 2 (BMI of 25 kg/m 2 [23–27]); 69% underwent cryoballoon ablation, 22% radiofrequency ablation, and 9% pulsed field ablation. The incidence of hypotension did not differ between groups. Hypoxic episodes were more frequent in group 1 (4 vs 2, P < .05), but none required mechanical ventilation. In multivariate analysis, obesity alone was not an independent risk factor for hypoxia or hypotension. Procedural duration, left atrial (LA) dwell time, and radiation dose were significantly higher in group 1. Overall complication rate was 3.4%, with no difference between groups. The 1-year success rate was comparable (71% vs 63%, P = .13). Subgroup analysis for persistent atrial fibrillation revealed a higher 1-year success rate (70% vs 57%, P = .048) for group 1. Conclusion Obesity was not an independent risk factor for periprocedural hypoxia or hypotension and did not affect safety or long-term success. Obesity alone should not be considered a reason to exclude patients from undergoing PVI under DS.