Impact of obesity on procedural safety and 1-year outcomes after pulsed-field ablation for atrial fibrillation
Grégoire Massoullié, Corentin Chaumont, Mikael Laredo, Bruno Pereira, Olivier Thomas, Philippe Maury, Pascal Defaye, Serge Boveda, Eloi Marijon, William Escande, Antoine Roux, Franck Raczka, Yves Guyomar, Pierre Jaïs, Pierre Ollitrault, Mathieu Granier, Samir Fareh, Hugo Marchand, Bertrand Pierre, Selim Abbey, Antoine Noel, Antoine Da Costa, Fabrice Extramiana, Olivier Cesari, Laure Champ-Rigot, Ziad Khoueiry, Thibault Villemin, Sarah Traullé, Frédéric Treguer, Hugues Bader, Jean-Claude Deharo, Bruno Degand, Benoît Guy-Moyat, Didier Klug, Estelle Gandjbakhch, Alexandre Zhao, Maxime Beneyto, Sandrine Venier, Stéphane Combes, Antoine Lepillier, Marc Mielczarek, Nicolas Clementy, Aymeric Menet, Frédéric Sacher, Christian De Chillou, Romain Eschalier, Frédéric AnselmeAbstract
Aims
Obesity is associated with atrial fibrillation (AF), atrial remodelling, and cardiometabolic comorbidities. Whether baseline body mass index (BMI) influences procedural safety and effectiveness of pulsed-field ablation (PFA) remains uncertain. We evaluated the association of baseline BMI with procedural characteristics, periprocedural safety, and 1-year arrhythmia recurrence after first-time PFA for AF.
Methods and results
FRANCE-PFA is a nationwide registry including consecutive patients undergoing first-time AF ablation with a pentaspline PFA catheter. Patients with available BMI were categorized as <25, 25 to <30, 30 to <35, or ≥35 kg/m2. Periprocedural complications and 1-year atrial arrhythmia recurrence were assessed across BMI categories. Among 5223 patients, BMI was available in 4573 (87.6%). Higher BMI was associated with greater cardiometabolic burden, more persistent AF, larger atria, and more extensive ablation strategies, including fewer pulmonary vein isolation-only procedures and more additional lesion sets (all P < 0.001). Periprocedural complications remained infrequent (1.0%), with no significant difference across BMI categories. At 1 year, recurrence was driven mainly by AF type rather than obesity. Within paroxysmal and non-paroxysmal AF, recurrence rates were comparable between patients with BMI < 35 and ≥35 kg/m2 (13.8% vs. 9.1% and 22.9% vs. 23.3%, respectively; log-rank P = 0.925). Severe obesity was not associated with recurrence after multivariable adjustment (HR, 0.86; 95% CI, 0.65–1.14; P = 0.299), with similar findings when BMI was analysed continuously.
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.