Impact of Obesity in Hospitalized Patients Undergoing Catheter Ablation for Atrial Fibrillation.

Introduction: Morbid obesity is a well-known risk factor for the development of Atrial Fibrillation (AF); however, its influence in patients undergoing Catheter Ablation (CA) for AF is poorly recognized.

Methods: The NRD (2016-2020) was used to identify CA for AF. Cohorts were stratified as non-obese (BMI <25), obese (BMI 30-39), and morbidly obese (BMI ≥ 40). Multivariate regression and propensity-matched models were used.

Results: Among 83,767 CAs for AF, 10,590 (12.6%) were morbidly obese population. On propensity-matched cohorts (N: 5741), morbid obesity was associated with higher rates of acute HF (39.1% vs. 34.5%), sudden cardiac arrest (5.6% vs. 4.7%), post-procedural bleeding (1.95% vs. 1.36%), AKI (21.7% vs. 16.3%), and respiratory complications (18.9% vs. 13.2%). Morbid obesity was also associated with higher median LOS (4 vs. 3 days) and higher total cost ($43,768 vs. $39,026). From 2016-2020, the total cost increased irrespective of the obesity status (p_trend < 0.05); however, LOS showed a decreasing trend for non-obese (p_trend < 0.05) but remained the same for morbidly obese patients (p_trend > 0.05). The 30-day (11.7% vs. 8.4%) and 180-day (29.9% vs. 24.9%) all-cause readmission rates were significantly higher for the morbidly obese compared to non-obese patients. Post-discharge, AF was the most common cause (69.2% & 66.8%) for 30 and 180-day readmissions. Our subgroup analysis comparing obese (BMI 30-39) to non-obese showed higher rates of periprocedural acute HF and respiratory complications (p < 0.05).

Conclusion: Morbid obesity in patients undergoing CA for AF was associated with higher rates of periprocedural adverse events, healthcare-related burden, and readmission rates.