Long-term influence of body mass index on cardiovascular events after atrial fibrillation ablation

Background Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach in symptomatic patients. Obesity is a dominant driver of AF recurrence after ablation. However, being both overweight and underweight drives long-term cardiac and general health risks. Long-term data are needed to understand the influence of body mass index (BMI) on outcomes after ablation in regard to arrhythmia recurrence and cardiovascular outcomes. Methods All patients who underwent an index ablation with a BMI recorded and at least 3 years of follow-up were included (n = 1558). The group was separated and compared by index ablation BMI status (<= 20, 21-25, 26-30, > 30 kg/m(2)). Longterm outcomes included AF recurrence, stroke/TIA, heart failure (HF) hospitalization, and death. Results Patients with advancing BMI status were more likely to be male and have hypertension, a smoking history, diabetes, HF, and a prior cardioversion. Patients with a BMI <= 20 were more likely to have a moderate-high congestive heart failure, hypertension, age > 75, diabetes, stroke (CHADS(2)) score. At 3 years, recurrence rates of AF increased significantly with increasing BMI status (p = 0.02); paradoxically, there was a trend for increased stroke risk with decreasing BMI (p = 0.06). Long-term death rates tended to increase inversely with BMI status, and HF rates were greatest in the highest and lowest BMI groups. Conclusions Lower weight at AF ablation lowers arrhythmia recurrence risk. However, AF ablation patients who are normal or underweight remain at high risk of other cardiovascular outcomes including increased stroke risk with less AF burden.