Key result
Class III obesity (BMI ≥ 40) increased the risk of atrial fibrillation recurrence at 3 years after catheter ablation compared to normal weight (HR 1.30; 95% CI 1.06-1.60; p=0.01).
Why the study?
Obesity is a known risk factor for AF, but its impact on procedural complications, AF recurrence, and symptoms after catheter ablation required evaluation.
Does baseline obesity affect procedural complications, AF recurrence, and symptoms following catheter ablation in patients with atrial fibrillation?
Cohort (n=5,841)
No
Does baseline obesity affect procedural complications, AF recurrence, and symptoms following catheter ablation in patients with atrial fibrillation?
Hazard Ratio: 1.3 (95% CI 1.06–1.6)
Absolute Event Rate: 48% vs 35%
p-value: p=0.01
Morbid obesity (BMI ≥ 40) is associated with a higher risk of AF recurrence after catheter ablation, although the procedure remains safe and improves symptoms across all BMI categories.
Morbid obesity may raise post-ablation AF recurrence risk; leaves open whether targeted weight loss improves outcomes in randomized trials.
INTRODUCTION: Obesity is a well-known risk factor for atrial fibrillation (AF). We aim to evaluate the effect of baseline obesity on procedural complications, AF recurrence, and symptoms following catheter ablation (CA). METHODS: All consecutive patients undergoing AF ablation (2013-2021) at our center were enrolled in a prospective registry. The study included all consecutive patients with available data on body mass index (BMI). Primary endpoint was AF recurrence based on electrocardiographic documentation. Patients were categorized into five groups according to their baseline BMI. Patients survey at baseline and at follow-up were used to calculate AF symptom severity score (AFSS) as well as AF burden (mean of AF duration score and AF frequency score; scale 0: no AF to 10: continuous and 9 frequencies/durations in between). Patients were scheduled for follow-up visits with 12-lead electrocardiogram at 3, 6, and 12 months after ablation, and every 6 months thereafter. RESULTS: A total of 5841 patients were included (17% normal weight, 34% overweight, 27% Class I, 13% Class II, and 9% Class III obesity). Major procedural complications were low (1.5%) among all BMI subgroups. At 3 years AF recurrence was the highest in Class III obesity patients (48%) followed by Class II (43%), whereas Class I, normal, and overweight had similar results with lower recurrence (35%). In multivariable analyses, Class III obesity (BMI ≥ 40) was independently associated with increased risk for AF recurrence (hazard ratio, 1.30; confidence interval, 1.06-1.60; p = .01), whereas other groups had similar risk in comparison to normal weight. Baseline AFSS was lowest in normal weight, and highest in Obesity-III, median (interquartile range) 10 (5-16) versus 15 (10-21). In all groups, CA resulted in a significant improvement in their AFSS with a similar magnitude among the groups. At follow-up, AF burden was minimal and did not differ significantly between the groups. CONCLUSION: AF ablation is safe with a low complication rate across all BMI groups. Morbid obesity (BMI ≥ 40) was significantly associated with reduced AF ablation success. However, ablation resulted in improvement in QoL including reduction of the AFSS, and AF burden regardless of BMI.
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Tabaja et al. (2023) conducted a cohort in Atrial fibrillation (n=5,841). Class III obesity (BMI ≥ 40) vs. Normal weight was evaluated on Atrial fibrillation recurrence based on electrocardiographic documentation (HR 1.30, 95% CI 1.06-1.60, p=0.01). Class III obesity (BMI ≥ 40) increased the risk of atrial fibrillation recurrence at 3 years after catheter ablation compared to normal weight (HR 1.30; 95% CI 1.06-1.60; p=0.01).
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