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Background: Outcomes of catheter ablation of atrial fibrillation (AF) are variable and the predictors of success require further elucidation since the identification of correctable risk factors could help to optimize therapy. We aimed to assess the impact of body mass index (BMI) in the overall safety and efficacy of catheter ablation of AF, with emphasis on the use of cryoballoon ablation and novel oral anticoagulants.
Methods and Results: There were 2497 consecutive patients undergoing catheter ablation of AF in 7 European high volume centers were stratified according to BMI (normal weight <25 kg/m2, pre‐obese 25–30 kg/m2, obesity 30–35 kg/m2, and morbid obesity ≥35 kg/m2) and comparisons of procedural outcomes evaluated. Pre‐obese and obese patients presented more comorbidities (hypertension, diabetes mellitus, and sleep apnea), and had higher rates of non‐paroxysmal AF ablation procedures. The rate of atrial 12‐month arrhythmia relapse increased alongside with BMI (35.2%, 35.7%, 43.6%, and 48.0% P<0.001). During a median follow‐up of 18.8 months (interquartile range 11–28), after adjusting for all baseline differences, BMI was an independent predictor of relapse (hazard ratio=1.01 per kg/m2; 95% CI 1.01–1.02; P=0.002), adding incremental predictive value to obstructive sleep apnea. BMI was not a predictor for any of the reported complications. Using novel oral anticoagulants and cryoballoon ablation was safe and efficacy was comparable with vitamin‐K antagonists and radiofrequency ablation.
Conclusions: Obese patients present with a more adverse comorbidity profile, more advanced forms of AF, and have lower chances of being free from AF relapse after ablation. Use of novel oral anticoagulants and cryoballoon ablation may be an option in this patient group.
Two new species of Psyllocarpus sect. Psyllocarpus, P. itakangapyra Sobrado, J.A.M.Carmo & R.M.Salas sp. nov. and P. vianae Sobrado, J.A.M.Carmo & R.M.Salas sp. nov., from the “campo rupestre” of the state of Minas Gerais, southeastern Brazil, are here described and illustrated. We provide comments on their distribution, habitat, and preliminary conservation status, and discuss their taxonomy. In addition, we analyse floral, fruit, and seed micromorphology, as well as pollen grains of the new species. We also provide an updated identification key to the species of P. sect. Psyllocarpus.
The Sergipe-Alagoas Basin has one of the most complete, exposed lithological successions of the Cretaceous period in the continental margin of Brazil. It captures several phases of the evolution of the South Atlantic Ocean, including rift, gulf and drift. The upper Aptian–Albian Riachuelo Formation corresponds to the first stages of the southern proto-Atlantic Ocean invasion in that basin. The present study reviews the taxonomic identification and ecology of 39 ostracod species of this formation, proposing a new genus – Gabonorygma gen. nov. – and three new species – Praebythoceratina deltalata sp. nov., Gabonorygma sergipana gen. et sp. nov. and Brachycythere smithsoniana sp. nov. Other taxa include Conchoecia? sp. 1, Cytherella sp. 1, C. besrineensis comb. nov., Cytherelloidea aff. globosa, C. btaterensis, Bairdoppilata sp. 1, Bairdoppilata sp. 2, B. comanchensis comb. nov., B. pseudoseptentrionalis, Robsoniella falklandensis, Cetacella sp. 1, Paracypris eniotmetos, Harbinia sinuata?, H. crepata, Liasina sp. 1, Praebythoceratina amsittenensis comb. nov., P. trinodosa comb. nov., Patellacythere sp. 1, P. shimonensis comb. nov., Xestoleberis? sp. 1, Xestoleberis? sp. 2, Apatocythere? sp. 1, Neocythere? aff. pseudovanveeni, N. (Physocythere) tenuis, Aracajuia antiqua comb. nov., A. benderi, A. fragilis comb. nov., Eocytheropteron sp. 1, Metacytheropteron aff. minuta, Microceratina? sp. 1, M. azazoulensis, Veenia guianensis, Algeriana? sp. 1, Quasihermanites? sp. 1 and Sergipella viviersae.