Does obesity affect atrial fibrillation ablation outcomes? Insights from a national atrial fibrillation catheter ablation registry: One-year follow-up

Background Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and is associated with significant morbidity and mortality. Obesity is a known risk factor for AF, but its impact on the success of AF ablation and the risk of recurrence remains inconclusive. Objective This study evaluates the safety and efficacy of AF ablation across different obesity subgroups. Methods This prospective, nationwide, multicenter registry study included 878 patients who underwent AF ablation between January 2019 and December 2021. Participants were categorized into non-obese and obesity classes I-III (BMI ≥30 kg/m 2 ) per WHO classification. Procedural characteristics, clinical outcomes, and adverse events were collected. Primary endpoints were AF recurrence and rehospitalization within 1 year. Results AF recurrence at 1 year occurred in 23% of patients, with no significant differences between BMI groups. In multivariable analysis, none of the obesity subgroups were independently associated with recurrent AF or need for re-ablation. Female gender, systolic pulmonary artery pressure, and left atrium size were significant predictors of AF recurrence. Rehospitalization rates were higher in obesity classes I (aHR 2.2, p=0.02) and II (aHR 3.9, p<0.001). Diabetes was also an independent predictor of rehospitalization. Procedural safety was comparable across BMI categories, with no significant differences in major complications. Conclusion This study suggests that while obesity is associated with a higher rate of rehospitalization, it does not significantly impact the 12-months efficacy or safety of AF ablation. These findings support the continued use of AF ablation in obese patients, regardless of obesity class.