BMI and atrial fibrillation recurrence post catheter ablation: A dose-response meta-analysis

Introduction The evidence on the association between obesity and atrial fibrillation (AF) recurrence was equivocal. We aimed to evaluate the dose-response relationship between body mass index (BMI) and AF recurrence and adverse events. Methods A systematic literature search was conducted using PubMed, Europe PMC, EBSCO, ProQuest and Cochrane Library. Obesity was defined as BMI >= 28 kg/m(2). The primary outcome was AF recurrence, and the secondary outcome was adverse events. Adverse events were defined as procedure-related complications and cardio-cerebrovascular events. Results There were a total of 52,771 patients from 20 studies. Obesity was associated with higher AF recurrence (Odds ratio [OR] 1.30 [95% confidence interval [CI] 1.16-1.47], P < .001; I-2: 72.7%) and similar rate of adverse events (OR 1.21 [95% CI 0.87-1.67], P = .264; I-2: 23.9%). Meta-regression showed that the association varies by age (coefficient: -0.03, P = .024). Meta-analysis of highest versus lowest BMI showed that the highest group had higher AF recurrence (OR 1.37 [95% CI 1.18-1.58], P < .001; I-2: 64.9%) and adverse events (OR 2.02 [95% CI 1.08-3.76], P = .028; I-2: 49.5%). The linear association analysis for AF recurrence was not significant (P = .544). The dose-response relationship for BMI and AF recurrence was nonlinear (p(nonlinearity) < 0.001), the curve became steeper at 30-35 kg/m(2). For adverse events, an increase of 1% for every 1 kg/m(2) increase in BMI (OR 1.01 [95% CI 1.00-1.02], P = .001), the relationship was nonlinear (p(nonlinearity) = 0.001). Conclusion Obesity was associated with higher AF recurrence in patients undergoing catheter ablation. High BMI might be associated with a higher risk for adverse events. PROSPERO ID: CRD42020198787.