title: Long-term influence of body mass index on cardiovascular events after atrial fibrillation ablation.
abstract: BACKGROUND
  Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach in symptomatic patients. Obesity is a dominant driver of AF recurrence after ablation. However, being both overweight and underweight drives long-term cardiac and general health risks. Long-term data are needed to understand the influence of body mass index (BMI) on outcomes after ablation in regard to arrhythmia recurrence and cardiovascular outcomes.
  
  
  METHODS
  All patients who underwent an index ablation with a BMI recorded and at least 3 years of follow-up were included (n = 1558). The group was separated and compared by index ablation BMI status (≤20, 21-25, 26-30, >30 kg/m(2)). Long-term outcomes included AF recurrence, stroke/TIA, heart failure (HF) hospitalization, and death.
  
  
  RESULTS
  Patients with advancing BMI status were more likely to be male and have hypertension, a smoking history, diabetes, HF, and a prior cardioversion. Patients with a BMI ≤20 were more likely to have a moderate-high congestive heart failure, hypertension, age >75, diabetes, stroke (CHADS2) score. At 3 years, recurrence rates of AF increased significantly with increasing BMI status (p = 0.02); paradoxically, there was a trend for increased stroke risk with decreasing BMI (p = 0.06). Long-term death rates tended to increase inversely with BMI status, and HF rates were greatest in the highest and lowest BMI groups.
  
  
  CONCLUSIONS
  Lower weight at AF ablation lowers arrhythmia recurrence risk. However, AF ablation patients who are normal or underweight remain at high risk of other cardiovascular outcomes including increased stroke risk with less AF burden.
authors.affiliation: Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA. Thomas.bunch@imail.org.|Department of Internal Medicine, Stanford University, Palo Alto, CA, USA. Thomas.bunch@imail.org.|Intermountain Heart Rhythm Specialists, Intermountain Medical Center, Eccles Outpatient Care Center, 5169 Cottonwood St, Suite 510, Murray, UT, 84107, USA. Thomas.bunch@imail.org.
authors.forename: T Jared
authors.initials: TJ
authors.lastname: Bunch
authors.affiliation: Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA.
authors.forename: Heidi T
authors.initials: HT
authors.lastname: May
authors.affiliation: Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA.
authors.forename: Tami L
authors.initials: TL
authors.lastname: Bair
authors.affiliation: Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Crandall
authors.affiliation: Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cutler
authors.affiliation: Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Jacobs
authors.affiliation: Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Mallender
authors.affiliation: Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Muhlestein
authors.affiliation: Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Osborn
authors.affiliation: Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA.
authors.forename: J Peter
authors.initials: JP
authors.lastname: Weiss
authors.affiliation: Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Day
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality* / Q000601:surgery*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000401:mortality*; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D013851:Thinness / Q000401:mortality*; D016896:Treatment Outcome; D014589:Utah / Q000453:epidemiology
keywords: Atrial fibrillation; Atrial fibrillation ablation; Body mass index; Catheter ablation; Obesity; Outcomes