Key result
Class III obesity (BMI ≥40) was independently associated with an increased risk of atrial fibrillation recurrence after catheter ablation compared to normal weight (HR 1.30).
Why the study?
Obesity is a well-known risk factor for AF, but its effect on procedural complications, AF recurrence, and symptoms following catheter ablation required evaluation.
Does baseline obesity increase procedural complications and atrial fibrillation recurrence following catheter ablation in patients with atrial fibrillation?
Cohort (n=5,841)
No
Does baseline obesity increase procedural complications and atrial fibrillation recurrence following catheter ablation in patients with atrial fibrillation?
Hazard Ratio: 1.3 (95% CI 1.06–1.59)
Absolute Event Rate: 48% vs 35%
p-value: p=0.012
Catheter ablation for atrial fibrillation is safe and improves quality of life across all BMI groups, though morbid obesity (BMI ≥40) is independently associated with a higher risk of arrhythmia recurrence.
Morbid obesity may raise post-ablation AF recurrence risk without increasing complications; leaves open whether targeted weight loss improves outcomes.
Background Obesity is a well-known risk factor for atrial fibrillation (AF). Objective To evaluate the effect of baseline obesity on procedural complications, AF recurrence, and symptoms following catheter ablation (CA). Methods A total of 5841 patients undergoing AF ablation (2013-2021) were enrolled in a prospectively maintained registry. Primary endpoint was AF recurrence based on electrocardiographic documentation. Patients were categorized into 5 groups according to their baseline body mass index (BMI). Patients survey at baseline and at follow-up were used to calculate AF severity score (AFSS) as well as AF burden. Results Major procedural complications were low (1.5%) among BMI sub-groups. At 3 years AF recurrence was 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 was independently associated with increased risk for AF recurrence (HR=1.30, P=0.01), 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] vs 15 [10-21]. In all groups, CA resulted in 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. What is known? Obesity is an independent risk factor of atrial fibrillation (AF) Catheter ablation (CA) has emerged as a standard of care in arrhythmia management, leading to improvements in quality of life, reductions in hospitalizations, and potential reductions in major adverse clinical outcomes. More obese patients are being referred to catheter ablation of AF. What is new? AF ablation is safe with low complication rates across all BMI sub-groups (<1.5%) Morbid obesity (BMI ≥40) was associated with increased risk of AF recurrence after ablation Using patient reported outcomes, AF Ablation resulted in improvement of quality of life 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 (BMI 18.5-24.9) was evaluated on Atrial fibrillation recurrence after 90-day blanking period (HR 1.30, 95% CI 1.06-1.59, p=0.012). Class III obesity (BMI ≥40) was independently associated with an increased risk of atrial fibrillation recurrence after catheter ablation compared to normal weight (HR 1.30).
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