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AF Catheter Ablation Shown Safe, Effective Despite Obesity

Researchers published the study covered in this summary on medRxiv as a preprint that has not yet been peer reviewed.

Key Takeaways

  • Catheter ablation for atrial fibrillation (AF) had a low complication rate of 1.5% in patients regardless of their body mass index (BMI) in a review of more than 5800 patients enrolled in a prospective registry at one US tertiary-care center.

  • AF recurrence was significantly higher in people with class II (BMI 35-39.9) and class III obesity (BMI ≥ 40) compared with people with normal BMI during 3-year follow-up.

  • However, ablation significantly improved patient-reported quality of life and lowered AF burden in all BMI subgroups.

Why This Matters

  • Obesity is a risk factor for AF, and patients with obesity increasingly receive referrals for catheter ablation, which is a standard approach for managing AF. However, studies of the safety and efficacy of ablation for AF in patients with obesity have reported inconsistent results.

  • This is the largest single-center study to investigate the impact of BMI on safety, outcomes, and quality of life in patients undergoing catheter ablation for AF.

  • The findings suggest that AF ablation is safe in patients regardless of their BMI to reduce their AF burden and improve their quality of life, and it is reasonable to recommend this procedure for symptomatic patients regardless of their BMI.

  • The overall benefits of weight loss should not be overlooked, and a formal weight management program and possible bariatric surgery are options for selected patients.

Study Design

  • Researchers used data from a prospective Cleveland Clinic registry of consecutive patients who underwent catheter ablation for AF for the first time during 2013-2021 and had data available on their BMI.

  • Researchers classified patients as having normal BMI (18.5-24.9), overweight (BMI 25-29.9), or class I, II, or III obesity (BMI 30-34.9, 35-39.9, and > 40, respectively).

Key Results

  • Of the 5841 patients, 17% had normal weight, 34% had overweight, and 27%, 13%, and 9% had class I, II, and III obesity, respectively.

  • Major procedural complications occurred at an overall rate of 1.5% and had a similar incidence in all five BMI subgroups, ranging from a 1.1% rate in the 504 patients with class III obesity to a 1.9% rate among the 758 patients with class II obesity.

  • During an average follow-up of 15 months, 1533 patients (26%) had at least one AF episode after their postablation blanking period. During 3 years of follow-up, the rate of AF across all BMI < 35 subgroups ranged between 35% and 37%. The rate of AF recurrence was significantly higher among patients with a BMI ≥ 35, with a 43% rate among people with class II obesity and a 48% recurrence rate among those with class III obesity.

  • Patients with class III obesity had a significant 30% higher risk for AF recurrence compared with patients with normal BMI after adjusting for confounders. Patients in the other BMI groups did not have a significantly increased relative risk.  

  • A total of 2635 patients replied to the quality-of-life surveys. The median baseline AF severity score was lowest in the normal weight group and highest in the class III obesity group. After ablation, the scores improved by a similar amount in each of the various BMI subgroups.

  • AF burden scores dropped significantly among people in all five BMI classes, tracking with reductions in all five subgroups in both AF frequency and duration.


  • This was an observational study with inherent limitations, including possible confounding because of patient-referral bias.

  • Patients may have had asymptomatic AF recurrences.


  • The study did not receive any funding.

  • None of the authors had relevant financial disclosures.

This is a summary of a preprint research study “Impact of Obesity on Catheter Ablation of Atrial Fibrillation: Patient Characteristics, Procedural Complications, Outcomes and Quality of Life,” written by researchers from the Cleveland Clinic, Ohio, on medRxiv and provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on

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