Impact of Risk-Factor Modification on Arrhythmia Recurrence Among Morbidly Obese Patients Undergoing Atrial Fibrillation Ablation

Background: Morbid obesity is associated with prohibitively high arrhythmia recurrence rates following AF ablation.

Design: This was a single-center study comprising 239 patients with morbid obesity and symptomatic paroxysmal or persistent AF undergoing AF ablation compared to 239 patients with a BMI < 30 kg/m2 matched based on age, gender, ejection fraction, AF type, presence and type of heart failure and left atrial volume index.

Methods: Our primary outcome of interest was arrhythmia recurrence.

Results: During a mean follow-up of 29 months, arrhythmia recurrence was observed in 65% of the morbidly obese cohort compared to 27% of the control group (p<0.0001). Among those with morbid obesity, sleep apnea screening and treatment (91% vs. 40%, p<0.0001), blood pressure control (62% vs. 53%, p=0.001), glycemic control (85% vs. 56%, p=0.004) and weight loss ≥ 5% (33% vs. 57% in those who lost <5% and 83% in those who gained weight, p<0.0001) were associated with lower arrhythmia recurrence. Recurrent arrhythmia was observed in 1 (4%) patient who accomplished all 4 goals, compared to 36% who achieved 3 of 4, 85% who modified 2 of 4, and 97% of those who achieved 0-1 of 4. RFM was also associated with substantial reductions in the need for repeat ablation or DCCV and arrhythmia-related hospitalization (p<0.0001).

Conclusion: Risk-factor modification through pragmatic noninvasive means such as blood pressure and glycemic control, sleep apnea screening and treatment, and weight loss is associated with substantially lower rates of recurrent arrhythmia among morbidly obese patients undergoing AF ablation.