title: Impact of obesity on atrial fibrillation ablation: Patient characteristics, long-term outcomes, and complications.
abstract: There is an association between obesity and atrial fibrillation (AF). The impact of obesity on AF ablation procedures is unclear.
  
  
  
  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.
  
  
  
  We evaluated 2715 patients undergoing 3742 AF ablation procedures. BMI was ≥30 kg/m2in 1058 (39%) and ≥40 kg/m2in 129 (4.8%). Patients were grouped by BMI ranges (<25, 25-<30, 30-<35, 35-<40, and ≥40 kg/m2).
  
  
  
  As BMI increased from <25 to ≥40 kg/m2, 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 CHADS2scores 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/m2the 5-year ablation freedom from AF decreased from 67%-72% to 57% (P = .036). For paroxysmal AF, when BMI was ≥40 kg/m2ablation success decreased from 79%-82% to 60% (P = .064), and for persistent AF, when BMI was ≥35 kg/m2ablation success decreased from 64%-70% to 52%-57% (P = .021). For long-standing AF, there was no impact of BMI on outcomes (P = .624). In multivariate analysis, BMI ≥35 kg/m2predicted worse outcomes (P = .036). Higher BMI did not impact major complication rates (P = .336). However, when BMI was ≥40 kg/m2, minor (from 2.1% to 4.4%; P = .035) and total (from 3.5% to 6.7%; P = .023) complications increased.
  
  
  
  In patients undergoing AF ablation, increasing BMI is associated with more patient comorbidities and more persistent and long-standing AF. BMI ≥35 kg/m2adversely impacts ablation outcomes, and BMI ≥40 kg/m2increases minor complications.
authors.affiliation: Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California. Electronic address: rawinkle@aol.com.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Winkle
authors.affiliation: Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California.
authors.forename: R Hardwin
authors.initials: RH
authors.lastname: Mead
authors.affiliation: Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California.
authors.forename: Gregory
authors.initials: G
authors.lastname: Engel
authors.affiliation: Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Kong
authors.affiliation: Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California.
authors.forename: William
authors.initials: W
authors.lastname: Fleming
authors.affiliation: Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Salcedo
authors.affiliation: Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California.
authors.forename: Rob A
authors.initials: RA
authors.lastname: Patrawala
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D015992:Body Mass Index; D002140:California / Q000453:epidemiology; D017115:Catheter Ablation / Q000379:methods*; D015897:Comorbidity / Q000639:trends; D018450:Disease Progression; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Ablation; Ablation outcomes; Atrial fibrillation; Body mass index; Obesity