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June 27, 2026EP EuropaceOpen Access

Obesity linked to ~24% higher risk of arrhythmia progression in SCAF patients versus normal BMI.

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Why the study?

How body mass index relates to arrhythmia progression and outcomes in patients with device-detected subclinical AF is not well defined.

Does higher BMI increase the risk of arrhythmia progression and modify the treatment effect of apixaban versus aspirin in patients with subclinical AF?

Population

3,968 patients with SCAF <24 hours from the ARTESiA trial

Comparison

Overweight and obesity vs normal BMI

Design

Secondary analysis of a randomized trial

Follow-up

Median of 3.6 years

Key result

In patients with subclinical atrial fibrillation, obesity was associated with a higher risk of arrhythmia progression compared to normal BMI (aHR 1.24; 95% CI 1.05-1.48).

Authors

MVM VamosAVA VagvolgyiGDG Z Duray

Discussion

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Overview

Higher BMI associated with arrhythmia progression in subclinical AF; leaves open BMI interactions with apixaban and need for interventional trials.

Key Points

  • To evaluate how body mass index (BMI) relates to arrhythmia progression and outcomes in patients with subclinical atrial fibrillation.
  • Secondary analysis of the ARTESiA trial involving patients with subclinical atrial fibrillation.
  • BMI categories were defined, and associations with arrhythmia progression and clinical outcomes were modeled using regression analysis.
  • Potential interactions between BMI and treatment effects of apixaban versus aspirin were explored.
  • Arrhythmia progression occurred at 9.2% per year, more frequently in overweight (aHR 1.17, 95% CI 1.00-1.37) and obesity (aHR 1.24, 95% CI 1.05-1.48) categories.
  • Stroke or systemic embolism rates did not differ significantly across BMI categories (0.9-1.1% per year).
  • Major bleeding rates were higher in overweight (1.2%) and obesity (1.2%) compared to normal BMI (1.9%), with more pronounced increases in bleeding with apixaban in these groups.

Study Design

Type

Cohort (n=3,968)

Structured PICO

Does higher BMI increase the risk of arrhythmia progression and modify the treatment effect of apixaban versus aspirin in patients with subclinical AF?

P
Population
3,968 patients with subclinical atrial fibrillation <24 hours, followed for a median of 3.6 years.
E
Exposure
Overweight (BMI 25-29.9 kg/m²) and obesity (BMI ≥30 kg/m²)
C
Comparator
Normal BMI (18.5-24.9 kg/m²)
O
Outcome
Arrhythmia progression (SCAF ≥24 hours or clinical AF)composite

Main Result

Hazard Ratio: 1.24 (95% CI 1.05–1.48)

In patients with subclinical AF, higher BMI is associated with increased arrhythmia progression, and may amplify the bleeding risk associated with apixaban therapy without altering its stroke prevention benefits.

Cite This Study

Vamos et al. (2026) conducted a cohort in Subclinical atrial fibrillation (SCAF) (n=3,968). Obesity (BMI ≥30 kg/m²) vs. Normal BMI (18.5-24.9 kg/m²) was evaluated on Arrhythmia progression (SCAF ≥24 hours or clinical AF) (aHR 1.24, 95% CI 1.05-1.48). In patients with subclinical atrial fibrillation, obesity was associated with a higher risk of arrhythmia progression compared to normal BMI (aHR 1.24; 95% CI 1.05-1.48).

synapsesocial.com/papers/6a3f97f8125782b61d865bbbhttps://doi.org/10.1093/europace/euag105.345
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