Impact of BMI and Type of Ablation Procedure on Atrial Fibrillation Recurrence in Japanese Patients

Abstract

Background: AF recurs more frequently after catheter ablation in individuals with a high BMI than it does in those with a normal BMI. However, the association between AF recurrence and BMI may be influenced by race. The authors investigated the relationship between BMI and AF recurrence after catheter ablation in Japanese patients. Methods: They enrolled 726 consecutive patients with paroxysmal or persistent AF (241 patients classified as overweight/obese [BMI ≥25 kg/m2] and 485 classified as non-overweight/obese [BMI <25 kg/m2]) who underwent cryoablation or radiofrequency ablation. The relationship between BMI and AF recurrence was assessed. Results: AF recurred in 183 patients (25.2%; 105 with paroxysmal AF and 78 with persistent AF). Median BMI differed significantly between patients with and without AF recurrence (23.9 kg/m2 [interquartile range: 21.6–26.9] versus 23.2 kg/m2 [interquartile range: 21.3–25.4]; p=0.011). Fisher’s exact test showed that the AF recurrence rate increased significantly with BMI in the radiofrequency ablation group (non-overweight/obese: 23.9% versus overweight/obese: 44.6%; p<0.001) but not in the cryoablation group (non-overweight/obese: 19.3% versus overweight/obese: 18.0%; p=0.883). Patients classified as overweight/obese had a significantly larger left atrial dimension, and left atrial dimension increased synergistically with persistent AF and increasing BMI. Conclusion: The AF recurrence rate in Japanese patients who underwent radiofrequency ablation, but not in those who underwent cryoablation, increased with BMI (especially BMI ≥25 kg/m2). Cryoablation may be superior to radiofrequency ablation in Japanese patients classified as overweight/obese.