Impact of obesity on atrial fibrillation ablation: Patient characteristics, long-term outcomes, and complications

BACKGROUND There is an association between obesity and atrial fibrillation (AF). The impact of obesity on AF ablation procedures is unclear. OBJECTIVE The purpose of this study was to evaluate the influence of body mass index (BMI) on patient characteristics, long-term ablation outcomes, and procedural complications. METHODS We evaluated 2715 patients undergoing 3742 AF ablation procedures. BMI was >= 30 kg/m(2) in 1058 (39%) and >= 40 kg/m(2) in 129 (4.8%). Patients were grouped by BMI ranges (<25, 25-,<30, 30-, <35, 35-, <40, and >= 40 kg/m(2)). RESULTS As BMI increased from, <25 to >= 40 kg/m(2), age decreased from 65.3 +/- 11.2 to 61.2 +/- 9.2 years (P<.001), left atrial size increased from 3.91 +/- 0.68 to 4.72 +/- 0.62 cm (P<.005), and CHADS(2) scores increased from 1.24 +/- 1.10 to 1.62 +/- 1.09 (P,.001). As BMI increased, paroxysmal AF decreased from 48.0% to 16.3% (P<.0001) and there was an increase in dilated cardiomyopathy (from 7.6% to 12.4%; P<. 0001), hypertension (from 41.0% to 72.9%; P<.0001), diabetes (from 4.3% to 23.3%; P<.0001), and sleep apnea (from 7.0% to 46.9%; P<.0001). For the entire cohort, for BMI >= 35 kg/m(2) the 5-year ablation freedom from AF decreased from 67%-72% to 57% (P 5.036). For paroxysmal AF, when BMI was >= 40 kg/m(2) ablation success decreased from 79%82% to 60% (P =.064), and for persistent AF, when BMI was >= 35 kg/m(2) ablation success decreased from 64%-70% to 52%57% (P =.021). For long-standing AF, there was no impact of BMI on outcomes (P 5.624). In multivariate analysis, BMI >= 35 kg/m(2) predicted worse outcomes (P =.036). Higher BMI did not impact major complication rates (P =.336). However, when BMI was >= 40 kg/m(2), minor (from 2.1% to 4.4%; P =.035) and total (from 3.5% to 6.7%; P =.023) complications increased. CONCLUSION In patients undergoing AF ablation, increasing BMI is associated with more patient comorbidities and more persistent and long-standing AF. BMI >= 35 kg/m(2) adversely impacts ablation outcomes, and BMI >= 40 kg/m(2) increases minor complications.