Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Clinical Trials / Outcomes D-PO03 - Poster Session III (ID 48) Poster

D-PO03-155 - Residual Obesity During Long Follow-up Is A Risk Factor Of Very Late Arrhythmia Recurrence After Catheter Ablation For Atrial Fibrillation (ID 346)


Background: Very late arrhythmia recurrence (VLR) one year post atrial fibrillation (AF) ablation remains significant. Residual obesity could cause VLR due to substrate progression.
Objective: To evaluate the impact of obesity and BMI status change during follow-up on VLR after AF ablation.
Methods: We enrolled 374 consecutive patients with BMI≥25 who underwent de novo AF ablation. Patients with BMI<25 or <2 years follow-up were excluded. BMI at pre-ablation and last follow-up were categorized as BMI<30 or BMI≥30.
Results: Of the 374 pts (60±10 years; 64% males; 54% with paroxysmal AF), 12 of 178 with pre-BMI<30 gained weight to BMI≥30 and 55 of 196 pts with pre-BMI≥30 reduced to BMI<30 over a median follow-up of 6.3 years (IQR 4.1-8.8). After final ablation, 79 (21%) pts had AF recurrence before one year and 108 (29%) had VLR at a median 2.6 years (IQR 1.7-3.8) post last ablation. BMI≥30 at final follow-up was significantly associated with VLR compared to BMI<30 (HR 2.38, P<0.001, Fig1A). Patients with BMI<30 who increased BMI≥30 had worse outcomes. Patients with BMI≥30 before ablation and who reduced BMI<30 at last follow-up had better outcome compared to patients who had no BMI status change (Fig1B-C). Multivariate Cox regression models after adjusting for potential risk factors demonstrated BMI≥30 at final follow-up (HR 2.4, P<0.001), older age (HR 1.03, P=0.02), high diastolic blood pressure (HR 1.02, P=0.02) and right atrium dilation (HR 1.09, P=0.007) were independent predictors of VLR.
Conclusion: Residual obesity with BMI≥30 during follow-up was associated with an increased risk of VLR. This result suggests the importance of weight management targeting BMI<30 to reduce VLR in obese cohort.