Article Text


Original research article
Obesity is associated with impaired long-term success of pulmonary vein isolation: a plea for risk factor management before ablation
  1. Gijs E De Maat1,2,
  2. Bart Mulder1,
  3. Wouter L Berretty1,
  4. Meelad I H Al-Jazairi1,
  5. Yong E S Tan1,
  6. Ans C P Wiesfeld1,
  7. Massimo A Mariani1,
  8. Isabelle C Van Gelder1,
  9. Michiel Rienstra1 and
  10. Yuri Blaauw1
  1. 1 Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  2. 2 Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Gijs E De Maat;{at}


Aims Obesity is an increasing health problem and is an important risk factor for the development of atrial fibrillation (AF). We investigated the association of body mass index (BMI) on the safety and long-term efficacy of pulmonary vein isolation (PVI) for drug-refractory AF.

Methods 414 consecutive patients who underwent transcatheter PVI for AF between 2003 and 2013 were included. Successful PVI was defined as absence of atrial arrhythmia on Holter monitoring or ECG, without and with antiarrhythmic drugs during follow-up. Obesity was defined as BMI≥30 kg/m².

Results Mean age was 56±10 years, 316 (76%) were male, 311 (75%) had paroxysmal AF and 111 (27%) were obese. After a mean follow-up of 46±32 months (1590 patient-years), freedom from atrial arrhythmia and antiarrhythmic drugs was significantly lower in patients with obesity compared with non-obese patients (30% vs 46%, respectively, P=0.005, log-rank 0.016). With antiarrhythmic drugs, freedom from atrial arrhythmia was 56% vs 68% (P=0.036). No differences in minor and major adverse events were observed between patients with obesity and non-obese patients (major 6% vs 3%, P=0.105, and minor 5% vs 5%, P=0.512). Sensitivity analyses demonstrated that BMI (as continuous variable) was associated with PVI outcome (HR 1.08, 95% CI 1.02 to 1.14, P=0.012).

Conclusion Obesity is associated with reduced efficacy of PVI for drug-refractory AF. No relation between obesity and adverse events was found.

  • atrial fibrillation
  • radiofrequency ablation (rfa)
  • obesity

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors GedM and BM conducted the analysis. GEdM, BM, MAM and MR wrote the manuscript. YB and IVG designed the study. MIHA-J and WLB assisted in data gathering, processing and statistical analysis. YEST, ACPW, IVG and YB revised the manuscript critically for important intellectual content.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained for the procedure.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All available data are reported in the article.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles