Impact of Obesity on Catheter Ablation of Atrial fibrillation: Patient Characteristics, Procedural Complications, Outcomes and Quality of Life

Abstract

AbstractBackgroundObesity is a well-known risk factor for atrial fibrillation (AF).ObjectiveTo evaluate the effect of baseline obesity on procedural complications, AF recurrence, and symptoms following catheter ablation (CA).MethodsA 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.ResultsMajor 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.ConclusionAF 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 ablationUsing patient reported outcomes, AF Ablation resulted in improvement of quality of life regardless of BMI