Arrhythmias & electrophysiology
Impact of obesity on procedural safety and 1-year outcomes after pulsed-field ablation for atrial fibrillation
Authors' conclusion
In this nationwide PFA cohort, higher BMI identified a more advanced AF phenotype and more extensive ablation strategies but was not independently associated with periprocedural complications or 1-year arrhythmia recurrence.
Study context
- Population
- Patients undergoing first-time AF ablation with a pentaspline pulsed-field ablation (PFA) catheterBody mass index (BMI) available in 4573 (87.6%)
- Participants
- 5,223 patients
- Exposure
- Periprocedural complications and 1-year atrial arrhythmia recurrence across BMI categories
- Outcome
- Cardiometabolic burden, persistent AF, atrial size and ablation strategy with higher BMI
Methodological detailsconsecutive patients
- Consecutive patients
Main finding
As reported in the abstract
- Higher BMI associated with greater cardiometabolic burden, more persistent AF, larger atria, fewer pulmonary vein isolation-only procedures and more additional lesion sets
- all P < 0.001
Observational data: associations, not effects.
Further findings
1-year atrial arrhythmia recurrence by AF type, BMI < 35 vs ≥35 kg/m²
- Paroxysmal AF: BMI < 35 kg/m²
- 13.8%
- Paroxysmal AF: BMI ≥35 kg/m²
- 9.1%
- Non-paroxysmal AF: BMI < 35 kg/m²
- 22.9%
- Non-paroxysmal AF: BMI ≥35 kg/m²
- 23.3%
- Recurrence driven mainly by AF type rather than obesity
- Log-rank P = 0.925
Recurrence, severe obesity (multivariable adjustment) · 1 year
- Severe obesity not associated with recurrence after multivariable adjustment: HR, 0.86
- P = 0.299 (95% CI 0.65-1.14)
- Similar findings when BMI analysed continuously
- Comparator group of the HR not stated
Safety
- Periprocedural complications, overall
- 1.0%
- No significant difference across BMI categories
Original publication
Impact of obesity on procedural safety and 1-year outcomes after pulsed-field ablation for atrial fibrillation. Europace. Published 29 October 2026. doi:10.
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