Weight change does not impact the long-term outcomes following pulmonary vein isolation in obese patients with atrial fibrillation

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Abstract Background Weight loss has been shown to reduce the burden of atrial fibrillation (AF) in obese patients. However, there are limited data on the impact of weight loss on long-term outcomes in patients with atrial fibrillation (AF) who undergo pulmonary vein isolation (PVI). Objective To understand the impact of weight change, as assessed by freedom from recurrent AF, in obese patients undergoing cryoballoon (CB) PVI. Methods We enrolled consecutive obese (BMI ≥ 30 kg/m2) patients with AF who underwent CB PVI; all patients had an implantable loop recorder (ILR) for long-term ECG monitoring. The cohort was divided into 3 groups based on their weight change 1-year after ablation: (1) weight loss (WL) > 3% weight decrease; (2) no weight change (NWC) - weight change < 3%, (3) weight gain (WG) > 3% weight increase. We assessed long-term AF recurrences, after excluding an initial 3-month post-ablation blanking period. Results Out of total of 137 pts with obesity, 61 pts had weight available at the ablation and at 1-year follow-up (65 ± 9 years; 41 [67%] male; 23 [38%] PAF; CHA2DS2-VASc 2.9 ± 1.7). There were no differences in baseline characteristics. At follow-up, 24 (39%), 26 (43%), and 11 (18%) pts lost, had no change, or gained weight, respectively. Of the 24 pts who lost weight, 3 pts lost > 10% body weight. During a follow-up of 964 ± 512 days, 41 (67%) pts had recurrent AF; the change in weight did not impact outcomes (Figure), including those who lost > 10% body weight. Conclusions During 3-years of follow-up, 2/3 of obese patients had objective evidence of AF recurrence following CB PVI. Weight change in the first-year post ablation did not alter long-term outcomes. Other strategies may be needed in these patients to improve outcomes.