BMI, race and AF recurrence post ablation: a meta-analysis and systematic review

Area of Science:

• Cardiology
• Electrophysiology
• Public Health

Background:

• Obesity is a known risk factor for atrial fibrillation (AF).
• The impact of obesity and race on AF recurrence post pulmonary vein isolation (PVI) requires further investigation.
• Understanding these factors is crucial for optimizing PVI outcomes.

Purpose of the Study:

• To investigate the association between body mass index (BMI) and AF recurrence after PVI.
• To explore potential racial differences in this association.
• To identify risk factors contributing to AF recurrence post PVI.

Main Methods:

• Systematic literature search across multiple databases (PubMed, Web of Science, etc.) up to May 2025.
• Inclusion of 26 studies with 35,237 participants.
• Meta-analysis and meta-regression to analyze primary outcome (AF recurrence) and secondary outcomes (procedural complications, echocardiographic parameters).

Main Results:

• A linear positive correlation exists between BMI and AF recurrence post PVI; a 5-unit BMI increase correlates with a 9% higher recurrence risk.
• Obese Europeans and North Americans showed increased recurrence risk (9% and 14%, respectively), while Asians exhibited the highest increase (37%).
• Enlarged left atrial diameter was identified as a risk factor for AF recurrence; no significant difference in procedural complications between obese and non-obese groups was found.

Conclusions:

• Higher BMI is associated with increased AF recurrence risk following PVI.
• Racial disparities significantly influence AF recurrence post PVI, with Asian patients experiencing higher risks.
• Enlarged left atrial diameter may be a key mechanism driving AF recurrence post PVI.