Impact of overweight and obesity on radiation dose and outcome in patients undergoing pulmonary vein isolation by cryoballoon and pulsed field ablation

Pulmonary vein isolation (PVI) using pulsed field ablation (PFA) or cryoballoon ablation (CBA) are commonly used single-shot techniques for the treatment of patients with atrial fibrillation (AF). The number of overweight (BMI 25–30 kg/m 2 ) and obese (BMI>30 kg/m 2 ) patients undergoing PVI is increasing, but data on this patient population is limited. Consecutive AF patients with a BMI ≥25 kg/m 2 undergoing PFA- or CBA-PVI were included in this retrospective analysis. Baseline characteristics, procedural parameters and 1-year AF-freedom were retrospectively analyzed and compared for both ablation modalities. Of 115 patients (66 % men, 64 years [IQR: 58–71 years], 57 % overweight and 43 % obese) PFA- was performed in 68 % and CBA-PVI in 32 %. Contrast-dye volume (PFA: 80 ml [IQR: 60 − 117 ml] vs. CBA: 130 ml [IQR: 95 − 200 ml], P =0.001) and radiation exposure (PFA: 2196 cGy·cm 2 [IQR: 1398 − 2973 cGy·cm 2 ] vs. CBA: 3239 cGy·cm 2 [IQR: 1288 − 5062 cGy·cm 2 ], P =0.009) was lower in patients undergoing PFA-PVI. Logistic regression analysis identified obesity (OR: 5.58, 95 % CI: 1.63–19.06; P =0.006) and CBA-PVI (OR: 12.93, 95 % CI: 3.51–47.68; P < 0.001) to be associated with increased radiation exposure. Both techniques were comparably safe (PFA: 4 % vs. CBA: 0 %; P =0.3). The median follow-up time was 145 days [IQR: 103 − 294 days]. AF-freedom after 1-year was similar in overweight (82 %) and obese patients (67 %) (HR: 0.61; 95 % CI: 0.29–1.28; P =0.19) as well as in PFA- and CBA-PVI patients (76 % vs. 76 %, HR: 1.37; 95 % CI: 0.63–2.99; P =0.42). Overweight and obese patients undergoing PFA-PVI had lower contrast-dye volume compared to CBA-PVI. Obesity was associated with increased radiation exposure. Both techniques were comparably safe. The 1-year AF-freedom was similar in overweight and obese patients.