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Female sex, particularly in combination with high body mass index and prolonged left atrial conduction indices, is associated with a significantly higher risk of atrial fibrillation recurrence following pulmonary vein isolation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 3, 2026Open Access

Sex-specific impact of body mass index on recurrence of atrial fibrillation after catheter ablation

Key Points

AF recurrence was significantly higher in women at 57% compared to 44.4% in men during follow-up.
High body mass index and prolonged atrial conduction indices were linked to increased AF recurrence in women.

Structured PICO

Does sex and body mass index impact the recurrence of atrial fibrillation after pulmonary vein isolation?

Population

387 consecutive patients (121 women and 266 men) who underwent first pulmonary vein isolation (PVI) for atrial fibrillation (AF) from 2014 to 2019. Mean age 66 years; 49.2% with BMI ≥30.

Intervention

First pulmonary vein isolation (PVI) for atrial fibrillation

Comparator

Men versus women, and BMI categories (BMI ≥30 vs <30)

Outcome

Recurrence of atrial fibrillation (AF)hard clinical

Female sex, particularly when combined with high BMI and prolonged left atrial conduction indices, is associated with a significantly higher risk of AF recurrence after pulmonary vein isolation.

Abstract

ABSTRACTBackground Sex-specific differences in the clinical outcome of pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) remain controversial. The impact of body mass index (BMI) on sex-based variation in the outcome of PVI is not well understood. Objective We sought to investigate the impact of BMI with associated atrial conduction indices (ACI) on sex-specific differences in AF recurrence after PVI. Methods All consecutive patients who underwent first PVI for AF from 2014 to 2019 were included. ACI were measured on surface electrocardiogram (ECG) and intracardiac electrogram (EGM). Data was collected and analyzed based on BMI and sex. Results The study included 387 patients with AF (121 women and 266 men; mean age 66 years; 49.2% with BMI ≥30). Women were older at the time of the procedure (median age 67 versus 62 years, P0.05). Post-PVI atrial flutter (AFL) occurred more often in women (21.5% versus 10.9%, P=0.009). Female sex, enlarged left atria, prolonged ACI, and post-PVI AFL were predictors of AF recurrence (PConclusion Female sex was associated with higher risk of AF recurrence after PVI and post-PVI AFL. Women with high BMI and prolonged left ACI had the highest rate of AF recurrence. This highlights the importance of weight management.

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