Impact of obesity and early recurrence of atrial fibrillation on very late recurrence following cryoballoon pulmonary vein isolation

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Abstract Background Obesity and early recurrence of atrial fibrillation (ERAF) post cryoballoon (CB) pulmonary vein isolation (PVI) both portend a lower 1-year success rate of ablation. Even after an initial successful ablation, about 1/3 of patients develop a very late recurrence (VLR) of AF, defined as the first AF recurrence more than a year after ablation (excluding an initial 90 day blanking period [BP]). The impact of obesity and ERAF on VLR is still unknown. Purpose To evaluate the impact of obesity and ERAF on VLR following CB PVI. Methods We enrolled consecutive patients with symptomatic AF who underwent CB PVI and had an implantable loop recorder for long-term ECG monitoring. We identified patients who had no AF recurrence (outside the BP) in the first-year post ablation. ERAF was defined as any episode of AF recorded in the first 90 days post ablation. Patients were grouped as either obese (BMI ≥ 30 kg/m2) or non-obese (BMI <30 kg/ m2). AF recurrences after 1-year post-ablation were ascertained using the loop recorder. Results From the initial cohort of 210 patients, 109 (52%) patients (64 ± 10 years; 75 [68%] male; 64 [59%] PAF; CHA2DS2-VASc 2.3 ± 1.4, 38 [35%] with obesity and 41 [38%] had ERAF) were AF-free during the first year. During a follow-up of 961 ± 196 days, 51 (47%) patients had VLR. Non-obese patients without ERAF had the best outcome (Figure). In multivariate analysis, obesity and ERAF were the only significant predictors of VLR (Table). As compared to non-obese patients without ERAF, obese patients with ERAF had a 4-fold greater likelihood of VLR. Conclusions About 50% of patients have no AF recurrence in the first year after CB PVI. Non-obese patients have the best outcome regardless of ERAF occurrence. On the other hand, obese patients with ERAF almost always have VLR.