最近有研究表明，与体重正常或偏瘦者的心房颤动（atrial fibrillation）患者比较，超重或肥胖的心房颤动患者接受经导管射频消融（ablation）治疗后可显著改善他或她们的生活质量，如更有活力，更少见焦虑和抑郁等。

心房颤动是一种非常常见的心律失常，多见于老年人、风湿性心脏病或冠心病、甲状腺功能亢进症等患者，有时亦可见于无明显异常者。中风是慢性心房颤动患者所潜在的主要风险，故有必要采取服药和/或射频消融，甚至手术的方式以转复患者的心律，或是分嘱患者服用华法令等抗凝药，以降低慢性房颤患者的中风风险。

经导管实施射频消融以治疗某些心律失常，如今在临床上非常常用，如仅在美国德州州府奥斯汀的St. David's Medical Center，每年就约有1600名患者接受该项治疗，表明该项治疗非常安全且有效。因此，有指征的心房颤动患者可以考虑接受经导管射频消融治疗，以改善生活质量与预后。

Obese Patients May Benefit the Most From Surgery for Irregular Heartbeat

They reported the greatest gains in quality of life, study finds

FRIDAY, Dec. 9 (HealthDay News) -- Overweight or obese individuals who undergo a procedure to treat an irregular heartbeat known as atrial fibrillation may see greater improvements in their quality of life after the treatment than their thinner counterparts.

The findings appear in the December edition of the journal HeartRhythm.

Atrial fibrilation (AF) greatly increases a person's risk for stroke. Many people with AF are treated with medications to help lower this risk. An alternative to medication, catheter ablation, treats AF by placing a thin tube (catheter) in the heart and burning off the tissue or pathways that are responsible for irregular heartbeat.

In the study, 79 percent of 660 participants were overweight or obese. The ablation procedure was equally successful at controlling the AF in both thin and heavyset individuals, but those who were obese and overweight showed greater gains in their quality of life. They did report a lower quality of life before the procedure than their thinner counterparts.

One year after the procedure, the overweight and obese participants reported feeling they had fewer limitations due to their physical health and emotional problems. They also reported increased vitality and less anxiety and depression after the procedure. By contrast, people with a normal body-mass index did not show "substantial" improvements in their quality of life after ablation.

"We have some reassuring news for the obese population because we are reporting improvements in quality of life when they undergo ablation for AF," said study author Dr. Sanghamitra Mohanty, a cardiologist at St. David's Medical Center in Austin, Texas. "However, this paper does not attempt to trivialize the importance of weight control," she said. Obesity is also a risk factor for AF and other diseases.

The findings touch on the so-called "obesity paradox," a phenomenon that shows that people who are obese may face a lower risk of death and complications after certain procedures than their thinner counterparts despite the known risks associated with the extra weight.

Most people with AF are treated with medications to control the abnormal heart rhythm and/or lower their risk for stroke. The new study could not say whether obese or overweight people could also expect a better quality of life if they are treated with medication over ablation. There is no data on how many ablation procedures to treat AF are performed yearly in the United States, but Mohanty and colleagues do about 1,600 a year at St. David's Medical Center.

Ablation does have some pluses when it comes to treating AF, said Dr. Robert Myerburg, a cardiology professor at the University of Miami School of Medicine. "It is good for people who have failed medication therapy, and does offer the hope of a permanent or near permanent cure. It's not a last resort, but another option in the treatment of AF."

As to the latest findings, "people who are obese and have successful ablation have a better quality of life than who are not obese," he said. They may have more to gain from the procedure in the first place, he noted, adding that the findings may not hold for people who are severely obese.

SOURCES: Robert Myerburg, M.D., cardiology professor, University of Miami School of Medicine, Miami; Sanghamitra Mohanty, M.D., cardiologist, St. David's Medical Center, Austin, Texas; December 2011 HeartRhythm