Key result
Obesity linked to ~12% greater risk of AF recurrence post-ablation.
Why the study?
It remained unclear whether the link between obesity and AF risk applies after pulmonary vein isolation, and whether racial differences exist.
Does higher BMI increase the risk of AF recurrence post PVI across different racial groups?
Meta-Analysis (n=35,237)
Yes
Does higher BMI increase the risk of AF recurrence post PVI across different racial groups?
There is a linear positive correlation between BMI and AF recurrence post-PVI, with significant racial disparities showing Asian patients at the highest risk.
May inform pre-PVI risk stratification in obese patients; leaves open whether weight reduction modifies recurrence across racial groups.
Aims Obesity increases atrial fibrillation (AF) risk, but it remains unclear whether this association can be extrapolated to AF patients who undergoing pulmonary vein isolation (PVI), and whether there are racial differences. This study aims to explore the role and interaction of body mass index (BMI) and racial factors in the risk of AF recurrence post PVI. Methods A systematic search was conducted in PubMed, Web of Science, Engineering Index, Wan Fang database, CNKI, and relevant meta-analyses from database inception to May 19, 2025. Standardized data extraction was performed in accordance with the Meta-analysis of Observational Studies in Epidemiology Reporting Guidelines. Primary outcome was the recurrence of AF post PVI. Secondary outcomes included procedural complications, and echocardiographic parameters. Results Finally, 26 studies involving 35,237 individuals were included. The results showed a linear positive correlation between BMI and the risk of AF recurrence post PVI. For every 5-units increase in BMI, the recurrence risk of AF increased by 9%. Subgroup analysis indicated that obese Europeans had a 9% higher recurrence risk ( P < 0.001), obese North Americans had a 14% higher recurrence risk ( P < 0.001), and Asians had the highest increase in recurrence risk, reaching 37% ( P < 0.001). Meta-regression analysis suggested that racial differences were potentially related to the strength of the association between BMI and AF recurrence ( P = 0.033). Risk factor analysis identified enlarged left atrial diameter as a potential risk factor contributing to the recurrence of AF ( P = 0.021). No statistically significant difference in surgical complications risk was observed between obese and non-obese populations ( P = 0.083). Conclusion Our findings confirm a linear positive correlation between BMI and the risk of AF recurrence post PVI. An enlarged left atrial diameter may be one potential mechanisms underlying AF recurrence. Furthermore, significant racial disparities were identified in AF recurrence risk, with Asian patients showing a significantly higher recurrence risk than European and American patients. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024496463 , PROSPERO CRD42024496463.
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Xuejiao et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=35,237). Obesity (High BMI) vs. Non-obesity (Normal BMI) was evaluated on Recurrence of atrial fibrillation post pulmonary vein isolation (RR 1.12, 95% CI 1.09-1.16, p=<0.001). Obesity increased the risk of atrial fibrillation recurrence post-ablation by 12% compared to non-obese patients, with the highest risk increase of 37% observed in Asian populations.
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