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

Raymond Pranata, Joshua Henrina, Emir Yonas, Iwan C.S. Putra, Irvan Cahyadi, Michael A. Lim, Dian A. Munawar, Muhammad Munawar

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


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/m2. 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; I2: 72.7%) and similar rate of adverse events (OR 1.21 [95% CI 0.87-1.67], P =.264; I2: 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; I2: 64.9%) and adverse events (OR 2.02 [95% CI 1.08-3.76], P =.028; I2: 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 (pnonlinearity < 0.001), the curve became steeper at 30-35 kg/m2. For adverse events, an increase of 1% for every 1 kg/m2 increase in BMI (OR 1.01 [95% CI 1.00-1.02], P =.001), the relationship was nonlinear (pnonlinearity = 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.

Original languageEnglish
JournalEuropean Journal of Clinical Investigation
Publication statusAccepted/In press - 2021


  • arrhythmia
  • Atrial Fibrillation
  • catheter ablation
  • obesity
  • pulmonary vein isolation


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