I’m finally being referred to a ep after 4 years of persistent AF, cardio version I had lasted less than a week but the benefits were my sleep apnoea scores lowered and so did my swollen ankles.
So my question is what was your BMI if you know when you had ablation ?
I’ve lost weight worked hard to do so and doing everything right it although I’ve been slack and it has creeped up over Xmas and now back to losing it again !
However my BMI still higher than 27 that I was told in clinic they like you to be. I did quote the NHS guidelines of 40 and told that’s just national and my hospital likes 27.
I’m not hopeful just want to know if anyone was in the over 35 -40 BMI range and if so did it work?
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Janelr
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There is no doubt that a BMI better than 26 often reduces AF burden. I doubt mine has ever been much above 27 since my diagnosis in 2004 and never below 25. I have never had BMI suggested as a reason for refusal of an ablation for AF but I do know of many cases where obsese patients are advised to loose weight before an ablation can be considered.
I’m worried how long it will take and the longer it’s left less chance I have of it working. Bariatric surgery was suggested for quick option but I really want to do myself.
Where does that BMI 26 number come from? Is there actually anything about that in the treatment guidelines for AF, such as the NICE guidelines? Or is it supported by published research? I know that excess weight comes with increased risk of many health issues, but that’s in general. I’m just wondering where this magic number of 26 comes from, and is this specific to AF?
The legacy trial results were about the decrease in aFib symptoms of those that lost a minimum of 10% of their starting weight in volunteers that had a BMI of 27 or higher , it didn't specify that a BMI of 26 was the optimum .The standardized BMI chart still classes a BMI of 26 as overweight, although it's at the lower end of that range.
The classification of BMI is
18.5 or Lower is Underweight
18.5-24.9 is Normal / Ideal BMI
24.9-29.9 is Medically Overweight
29.9 and over Medically Obese
The health burden, potential for active symptoms, and risk for cardiovascular issues developing or becoming chronic, including aFib, can increase in the Underweight group as well as in the Overweight group.
This is a fact that many people don't realise and many doctors don't always consider as much as they should.
Although BMI and Weight is only one of the factors that can cause increased risk for health issues like aFib they do also add to the work of the heart , affect blood pressure and heart rate and can cause other health related issues.
In relation to the original posters question :
Many NHS units generally prefer a BMI in the ideal range or a region within 27- 30 because of various pieces of research like the Legacy Trial about aFib on reducing the overall burden on various organs when undergoing surgery .
Even though it has a wider range to work within , the preferred BMI can differ depending on the type of surgery being undertaken, the type of condition that they are attempting to correct (and whether that condition can involve greater risk of a cardiac or breathing event during the procedure), whether the surgery is elective or a medical emergency, and the whole medical history and additional needs of the patient .
It prefers patients to be closer to the ideal BMI because of the additional risks associated with administering General Anaesthetic and potential complications that can occur during a procedure in a patient with a high or very low BMI and their additional cardiopulmonary risk factor score.
So, it is usually better for the success of the procedure and improvement in recovery time if someone takes a little longer to lose weight and gets as close as they can to the Surgery Recommendations for BMI for a non urgent surgery to give the patient the most optimal chance of post surgical success with a lower surgical risk.
Blearyeyed Thank you for sharing information about the Legacy study and for explaining weight as a risk factor for surgery and specifically for general anaesthetic. You have explained it in a way that will make sense to many people on this forum.
There have been a few newly diagnosed people who are living with obesity and this has been brought up by their doctors. Unfortunately they have just been left to ‘get on with it’ in this aspect of their health rather than being given adequate support and counselling about their weight, particularly when it a medical and not a vanity issue.
Having looked at the Legacy trial I’m not sure where this BMI 26 figure is from. It seems rather arbitrary, unless there’s something in the Legacy study data that I’m missing.
Of course, not everyone with AF is overweight, and being in the “healthy” BMI range does not exempt anyone from developing AF or any other condition for that matter. Underweight is also a significant risk factor for developing heart arrhythmias, and people with eating disorders irrespective of being underweight or in the normal range need to have regular ECGs and have their electrolytes monitored. The underweight/low weight population is not adequately studied in trials. It’s only relatively recently that women have been studied in trials because it is now acknowledged that female bodies are not the same as male bodies, yet females more than males have a longer history of being on and off weight loss diets all their adult lives, and the impact of this on their cardiac and other health parameters needs to be studied. But that’s a different topic entirely.
I looked at the Legacy Trial study which was on overweight/obese people with AF, and the impact of sustained weight loss on their AF burden. The weight loss was expressed as a percentage of their original baseline weight. However, I cannot see anything about an ideal BMI of 26, or a target BMI of 26 for the patients to aim for.
My EP told me that the risks (of the procedure) are increased by being significantly overweight or underweight and whilst I decided to lose weight to give the procedure the best chance, BMI was never discussed as a criteria for doing the procedure.
Very good point about the risks of being underweight too. It’s very much overlooked. A close friend of mine has had a lifelong battle with eating disorders, and still does, and I really do fear for her future (and present) health.
Be very careful with bmi as a bench mark, I say this because most rowers and rugby players come in with a high bmi due to muscle mass. My son at his medical for sandhurst had a high bmi they told him to remove his top put the fat callipers on him then told him to put a stone or or he wouldn’t survive training as he didn’t have enough fat reserves. He had always played rugby (winger) and cycled 24 miles to work a day.
If you’re overweight as I am, you will benefit from loosing weight before your procedure. It will aid recovery and outcome.
I've been told I cannot be offered an ablation until I reach 39 or lower BMI. I'm currently at 57. There are several studies about weight and ablation, better results the lower your BMI. With that said, I hate BMI as a measurement. I'm 5'3" - maybe I just need to grow taller?
I've been put on amiodarone as a bridge to weight loss. I'm using Zepbound, a glp-1, in a similar class to Ozempic, but less side effects and more effective. Once I reach 39 BMI (which for me is about 90lbs loss) I'll be a candidate for ablation. I am only 53, so this is what needs to happen. I've exhausted the medication only route.
ahh I’m same height and age, I’m in the criteria for bmi going of national guidelines but no where near the 27 they want. I’m going to do an exercise diary show them I’m not unfit and my food diary show them I eat good.
That’s great about the exercise and healthy eating. I think being able to demonstrate exercise and fitness will definitely be relevant in terms of recovery from the procedure.
Can I ask which hospital? I think different hospitals and maybe different EP’s have different rules they go by. I was once told by an arrhythmia nurse that BMI of 35 was the official cut off point for an ablation under GA in her hospital, but the EP could do it whatever the weight if the AF warranted it. But regardless of that, I understand the chances of it recurring are greater unless the BMI is lower (under 26) so it’s well worth pulling out the stops to do what you can. That’s what I did. (Am doing!)
Good luck with it - do let us know how you get on, and what they say? Jx
That’s a great hospital, isn’t it? You’ll be in good hands!
I’ve not yet booked an ablation, I always wuss out! But I want to get myself as fit and well as I possibly can be, to either avoid needing it altogether, or for when it becomes essential
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