Pulsed Field Ablation for Atrial Fibrillation in Patients With Obesity: Procedural and Clinical Outcomes

Procedural and clinical outcomes in patients with obesity undergoing catheter ablation for atrial fibrillation (AF) have been mixed. Clinical data in the context of pulsed field ablation (PFA) are currently limited in this patient cohort.

We conducted an observational study of consecutive patients undergoing PFA with a pentaspline catheter (Farapulse^TM, Boston Scientific) for AF at a tertiary center comparing procedural and clinical outcomes in patients with body mass index (BMI) <30 kg/m² (nonobese), 30-34.9 kg/m² (obese), and ≥35 kg/m² (morbidly obese). Baseline and procedural characteristics, procedural outcomes (major and minor complications) and clinical outcomes were collected. Arrhythmia recurrence was defined as AF, atrial flutter or atrial tachycardia >30 s at any follow-up.

537 (95%) out of 564 consecutive patients underwent de novo PFA for AF between 2022 and 2025 with a recorded BMI; 326 (60.7%) were nonobese, 117 (21.8%) were obese and 94 (17.5%) morbidly obese patients. Proportion of females increased according to BMI (p = 0.003). Obesity correlated with CHA₂DS₂-VASc score, hypertension, diabetes mellitus, obstructive sleep apnea and heart failure with reduced ejection fraction (p < 0.05 for all). Persistent AF was more common (p = 0.048). Radiation exposure was significantly increased in obese patients (p < 0.001). There was no difference in major (1.2%-3.2%) or minor (11%-15%) procedural complications between groups. There was no difference in freedom from arrhythmia recurrence between groups (67%-70% at median follow-up 5.9-7.4 months).

Patients with obesity had no signal of increased risk detected with regard to procedural safety and clinical outcomes with PFA for AF compared with nonobese patients. These findings apply to a specific pentaspline PFA catheter rather than PFA technology in general.