Key result
Obesity links to adverse left atrial remodeling but not 1-year AF recurrence after ablation.
Why the study?
Obesity and AF are strongly linked and both associated with significant LA pathology, but differences in LA size, function, and AF recurrence between obese and non-obese patients undergoing ablation required assessment.
Does obesity (BMI ≥30 kg/m2) impact left atrial size, pressure, function, and post-ablation arrhythmia recurrence in patients with atrial fibrillation undergoing first-time catheter ablation?
Observational (n=672)
No
Does obesity (BMI ≥30 kg/m2) impact left atrial size, pressure, function, and post-ablation arrhythmia recurrence in patients with atrial fibrillation undergoing first-time catheter ablation?
In AF patients undergoing first-time ablation, obesity is associated with higher left atrial pressure and larger left atrial size—which is better captured by indexing volume to height squared rather than BSA—without further impairing left atrial function or increasing 1-year AF recurrence.
Obesity links to larger LA volume and pressure without raising 1-year AF recurrence post-ablation; extends LA remodeling observations but leaves optimal indexing and long-term risk open.
Objectives: Obesity and atrial fibrillation (AF) are strongly linked and are both associated with significant left atrial (LA) pathology. This study aimed to assess differences in LA size and function between obese and non-obese AF patients and to evaluate AF recurrence in both groups. Materials and Methods: We retrospectively analyzed patients undergoing first-time ablation for AF. Obesity was defined as body mass index ≥30 kg/m2, and patients were divided accordingly into obese and non-obese groups. Results: Among 672 patients (median age of 66 years; 39.1% women), 308 (45.8%) were obese. Obese patients had significantly larger LA dimensions (LA area, LA volume, and LAVI indexed to height2 (but not that indexed to body surface area (BSA)); p < 0.001), as well as higher LA-pressure-related parameters (LA stiffness index (p = 0.004), E-wave velocity (p = 0.002), and E/e′ ratio (p < 0.001)) and invasively measured mean LA pressure (p < 0.0001). However, there were no significant differences in parameters directly reflecting LA function, such as LA emptying fraction, LA reservoir strain, or LA appendage velocity. These findings remained consistent in the sinus rhythm subgroup (n = 374). The 1-year AF recurrence rate did not differ between obese and non-obese groups (data available for 73.8% (496) patients; p = 0.40), regardless of baseline rhythm. Conclusions: In AF patients undergoing their first ablation, obesity was associated with a larger LA size and higher LA pressure. In obese individuals, indexing LA dimensions to height2 seems to better reflect LA enlargement than indexing to BSA. LA function and AF recurrence rates after a 1-year follow-up period were similar between obese and non-obese patients.
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Uziębło‐Życzkowska et al. (2025) conducted an observational in Atrial fibrillation (n=672). Obesity (BMI ≥ 30 kg/m²) vs. Non-obese (BMI < 30 kg/m²) was evaluated on Left atrial volume indexed to height² (LAVI/h²), mean left atrial pressure, and 1-year AF recurrence (p=<0.001 for LA dimensions/LAVI-height², <0.0001 for mean LA pressure, 0.40 for 1-year AF recurrence). Obesity in AF ablation patients was associated with larger LA volume indexed to height² (p<0.001) and higher mean LA pressure (p<0.0001), but similar LA function and 1-year AF recurrence (p=0.40).
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