Outcome and Treatment of Atrial Fibrillation in Obesity- Insights from the National Inpatient Sample Database

Background: Obesity is considered a significant risk factor for numerous cardiovascular conditions. The prevalence of atrial fibrillation (AF) is elevated among patients with obesity. Weight loss has been shown to reverse cardiac remodelling, leading to lower recurrence of AF despite the better prognosis in obese patients. Methods: A retrospective cohort analysis using the Nationwide Inpatient Sample (2016–2019) identified adult patients hospitalized with AF. Patients were categorized by BMI using ICD-10 codes. The primary focus was on procedural outcomes (electrical cardioversion {ECV} and cardiac ablation {CA}), given the limitations of the NIS database in capturing pharmacologic data. Variables like comorbidities, demographic factors, and obesity-related complications were adjusted for in the analysis. Multivariate logistic regression adjusted for demographics, hospital factors, and comorbidities. Results: The analysis included 1,625,809 weighted patients. Patients include underweight (6.66%), normal BMI (4.03), overweight (6.51%), obesity class I (20.65%), obesity class II (21.45%), and obesity class III (40.7). After multivariate regression analysis, patients with obesity class I, II, or III had higher odds of ECV, irrespectively of coronary risk factors (OR 1.3, 95% CI 1.25-1.37, OR 1.3, 95% CI 1.32-1.43, OR 1.3, 95% CI 1.29-1.38, respectively, with statistically significant P values). However, underweight or normal BMI patients had fewer odds of ECV (OR 0.5 95%CI 0.49-0.61 and OR 0.6 95%CI 0.58-0.74, respectively, with P values <0.001). Meanwhile, there was no statistical significance between a BMI and the odds of CA. Conclusion: Our study highlights the significant impact of obesity on AF management, as higher BMI increased the likelihood of ECV but not CA. Obesity complicates management through altered pharmacokinetics affecting anticoagulants and control strategies, with increased epicardial adipose tissue potentially worsening outcomes. Future research should explore epicardial adipose tissue (EAT) and treatment interventions in obesity-related AF.