In this nationwide PFA cohort, higher BMI identified a more advanced AF phenotype and more extensive ablation strategies but was not independently associated with periprocedural complications or 1-year arrhythmia recurrence.
BMI was available for most patients in the FRANCE-PFA registry, which enrolled consecutive patients undergoing first-time AF ablation with a pentaspline PFA catheter.
Higher BMI was associated with a greater cardiometabolic burden and a more advanced AF phenotype.
Higher BMI was associated with more extensive ablation strategies.
Periprocedural complications were infrequent and did not differ significantly across BMI categories.
One-year arrhythmia recurrence was driven mainly by AF type rather than obesity.
Severe obesity was not independently associated with 1-year recurrence after multivariable adjustment.
This study looked at whether body weight affects the safety and success of pulsed-field ablation, a newer catheter treatment for atrial fibrillation (AF) that uses short electrical pulses rather than heat or cold. It used a French nationwide registry of 4,573 patients with known body mass index (BMI) who were having their first AF ablation, and grouped them from normal weight to severely obese. People with higher BMI tended to have more advanced AF, such as persistent rather than occasional AF, larger atria, and more other health problems. They were also more likely to receive more extensive ablation than pulmonary vein isolation alone. Even so, serious complications were uncommon (1.0% overall) and did not differ significantly by BMI. After one year, return of arrhythmia depended mainly on the type of AF, not on obesity. People with severe obesity (BMI ≥35) did not have a higher risk of recurrence after statistical adjustment. This research suggests that pulsed-field ablation appears to be similarly safe and effective in the short term across a wide range of body weights. The study was an observational registry and followed patients for only one year, so it cannot show long-term outcomes or whether weight loss would change results.
Massoullié G, Chaumont C, Laredo M, Pereira B, Thomas O, Maury P, et al.. (2026). Impact of obesity on procedural safety and 1-year outcomes after pulsed-field ablation for atrial fibrillation.. 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/euag288