{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:43:35Z","timestamp":1785199415159,"version":"3.55.0"},"reference-count":25,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T00:00:00Z","timestamp":1715731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Management of atrial fibrillation (AF) in very severe obese patients is challenging. Cryoballoon ablation (CBA) represents an effective rhythm control strategy. However, data in this patient group were limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Highly symptomatic AF patients with body mass index (BMI)\u2009\u2265\u200940\u2009kg\/m<jats:sup>2<\/jats:sup> who had failed antiarrhythmic drug therapy and electrocardioversion and failure to achieve targeted body\u2010weight\u2010reduction underwent CBA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data of 72 very severe obese AF patients (Group A) and 129 AF patients with normal BMI (Group B, BMI\u2009&lt;\u200925\u2009kg\/m<jats:sup>2<\/jats:sup>) were consecutively collected. Group A had significantly younger age (60.6\u2009\u00b1\u200910.4 vs. 69.2\u2009\u00b1\u200911.2\u2009years), higher BMI (44.3\u2009\u00b1\u20094.3 vs. 22.5\u2009\u00b1\u20091.6\u2009kg\/m<jats:sup>2<\/jats:sup>). Procedural pulmonary vein isolation (PVI) was successful in all patients (2 touch\u2010up ablation in Group A). Compared to Group B, Group A had similar procedural (61.3\u2009\u00b1\u200922.6 vs. 57.5\u2009\u00b1\u200919\u2009min), similar fluoroscopy time (10.1\u2009\u00b1\u20095.5 vs. 9.2\u2009\u00b1\u20094.8\u2009min) but significantly higher radiation dose (2852\u2009\u00b1\u20092095 vs. 884\u2009\u00b1\u2009732\u2009\u00b5Gym<jats:sup>2<\/jats:sup>). We observed similar rates of real\u2010time\u2010isolation (78.6% vs. 78.5%), single\u2010shot\u2010isolation (86.5% vs. 88.8%), but significantly longer time\u2010to\u2010sustained\u2010isolation (53.5\u2009\u00b1\u200933 vs. 43.2\u2009\u00b1\u200925\u2009s). There was significantly higher rate of puncture\u2010site\u2010complication (6.9% vs. 1.6%) in Group A. One\u2010year clinical success in paroxysmal AF was (Group A: 69.4% vs. Group B: 80.2%; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), in persistent AF was (Group A: 58.1% vs. Group B: 62.8%; <jats:italic>p<\/jats:italic>\u2009=\u2009.889). In Re\u2010Do procedures Group A had a numerically lower PVI durability (75.0% vs. 83.6%, <jats:italic>p<\/jats:italic>\u2009=\u2009.089).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For very severe obese AF patients, CBA appears feasible, leads to relatively good clinical outcome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.16302","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T04:15:55Z","timestamp":1715832955000},"page":"1412-1421","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Cryoablation of atrial fibrillation in \u201cvery severe\u201d obese patients (BMI\u2009\u2265\u200940): Indications, feasibility, procedural safety and efficacy, and clinical outcome (the ICE\u2010Obese Extreme)"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5234-744X","authenticated-orcid":false,"given":"Lukas","family":"Urbanek","sequence":"first","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus Akademisches Lehrkrankenhaus der Goethe\u2010Universit\u00e4t Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5347-9906","authenticated-orcid":false,"given":"Boris","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus Akademisches Lehrkrankenhaus der Goethe\u2010Universit\u00e4t Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0282-4658","authenticated-orcid":false,"given":"Stefano","family":"Bordignon","sequence":"additional","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus Akademisches Lehrkrankenhaus der Goethe\u2010Universit\u00e4t Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Schaack","sequence":"additional","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus Akademisches Lehrkrankenhaus der Goethe\u2010Universit\u00e4t Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramin","family":"Ebrahimi","sequence":"additional","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus Akademisches Lehrkrankenhaus der Goethe\u2010Universit\u00e4t Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shota","family":"Tohoku","sequence":"additional","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus Akademisches Lehrkrankenhaus der Goethe\u2010Universit\u00e4t Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5588-0533","authenticated-orcid":false,"given":"Jun","family":"Hirokami","sequence":"additional","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus Akademisches Lehrkrankenhaus der Goethe\u2010Universit\u00e4t Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tolga Han","family":"Efe","sequence":"additional","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus Akademisches Lehrkrankenhaus der Goethe\u2010Universit\u00e4t Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3931-8652","authenticated-orcid":false,"given":"Karin","family":"Plank","sequence":"additional","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus Akademisches Lehrkrankenhaus der Goethe\u2010Universit\u00e4t Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Britta","family":"Schulte\u2010Hahn","sequence":"additional","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus Akademisches Lehrkrankenhaus der Goethe\u2010Universit\u00e4t Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Nowak","sequence":"additional","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus Akademisches Lehrkrankenhaus der Goethe\u2010Universit\u00e4t Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian K. 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