While obesity is associated with worse baseline status and outcomes, it was not shown to significantly alter the relative effectiveness of AF ablation compared to drug therapy in this post hoc analysis of CABANA.
This post hoc CABANA analysis included 2170 participants with available BMI and examined whether baseline obesity modifies the effect of catheter ablation versus drug therapy in atrial fibrillation.
Obese patients had a higher comorbidity burden, worse baseline functional status, and more persistent AF than non-obese patients.
Higher BMI was associated with increased cardiovascular hospitalization and a higher NYHA functional class.
Catheter ablation significantly reduced AF recurrence and improved symptom burden and functional capacity irrespective of obesity status.
No significant interaction was found between BMI and treatment effect on the primary composite endpoint of cardiovascular hospitalization or all-cause mortality.
Patients with Class II obesity or higher had worse absolute outcomes despite similar relative benefits from ablation.
The authors conclude that findings support a multifaceted approach combining rhythm control with upstream interventions targeting obesity-related atrial remodelling and comorbidity management.
Obesity and atrial fibrillation (AF, an irregular heart rhythm) often occur together. This study re-analysed data from the CABANA trial, which compared catheter ablation (a procedure to treat the heart tissue causing the abnormal rhythm) with drug therapy. It looked at 2170 participants with known body mass index to see whether obesity changes how well ablation works. People with obesity had more other health conditions, worse functional status at the start, and more persistent AF. Higher BMI was linked to more hospitalizations for heart-related reasons and worse heart-failure-type functional class. Still, ablation reduced AF recurrence and improved symptoms and physical function whether or not a person had obesity, and no significant difference in the effect of ablation on the combined outcome of heart hospitalization or death was found by BMI. Those with Class II obesity or higher had worse outcomes overall, even though the relative benefit of ablation was similar. This research suggests that obesity should not by itself rule out the benefits of ablation, but that people with obesity remain at higher risk. The authors point to combining rhythm treatment with efforts to address obesity and related conditions. As a post hoc analysis of a trial, it cannot prove cause and effect and should be interpreted with caution.
Erzeel J, Dhont S, van Es M, De Wever M, Meekers E, Van Herendael H, et al.. (2026). Impact of obesity on clinical outcomes and the treatment effect of catheter ablation in atrial fibrillation: insights from CABANA.. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. https://doi.org/10.1093/europace/euag293