Body mass index and pulmonary vein isolation; real-world data on outcomes and quality of life.

BACKGROUND AND AIMS: Increasing numbers of overweight and obese patients undergo pulmonary vein isolation (PVI), despite the association between higher body mass index (BMI) and adverse PVI outcomes. Evidence on complications and quality of life in different bodyweight groups is limited. This study aims to clarify the impact of BMI on repeat ablations, periprocedural complications and change in quality of life.

METHODS: This multicentre study analysed prospectively collected data from 15 ablation centres, covering all first-time PVI patients in the Netherlands from 2015 to 2021. Patients were categorized by BMI: normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obesity (≥30 kg/m2). Quality of life was assessed using the AFEQT questionnaire at baseline and one-year post-PVI.

RESULTS: Among 20,725 patients, 30% were of normal weight, 47% overweight and 23% obese. Within the first year after PVI, obese patients had a higher incidence of repeat ablations than normal-weighing and overweight patients (17.8% versus 15.6% and 16.1%, P <0.05). Obesity was independently associated with repeat ablations (odds ratio 1.15; 95%-confidence interval 1.01-1.31, P = 0.03). This association remained apparent after 3 years. Complication rates were 3.8% in normal weight, 3.0% in overweight, and 4.6% in obese, with weight class not being an independent predictor. Quality of life improved in all weight groups post-PVI, but remained lowest in obese patients.

CONCLUSIONS: Obesity is independently associated with a higher rate of a repeat ablations. PVI is equally safe in all weight classes. Despite lower quality of life among obese individuals, substantial improvements occur for all weight groups after PVI.