{ "abstract": "Aims\n\nObesity is associated with atrial fibrillation (AF), atrial remodelling, and cardiometabolic comorbidities. Whether baseline body mass index (BMI) influences procedural safety and effectiveness of pulsed-field ablation (PFA) remains uncertain. We evaluated the association of baseline BMI with procedural characteristics, periprocedural safety, and 1-year arrhythmia recurrence after first-time PFA for AF.Methods and results\n\nFRANCE-PFA is a nationwide registry including consecutive patients undergoing first-time AF ablation with a pentaspline PFA catheter. Patients with available BMI were categorized as <25, 25 to <30, 30 to <35, or ≥35 kg/m2. Periprocedural complications and 1-year atrial arrhythmia recurrence were assessed across BMI categories. Among 5223 patients, BMI was available in 4573 (87.6%). Higher BMI was associated with greater cardiometabolic burden, more persistent AF, larger atria, and more extensive ablation strategies, including fewer pulmonary vein isolation-only procedures and more additional lesion sets (all P < 0.001). Periprocedural complications remained infrequent (1.0%), with no significant difference across BMI categories. At 1 year, recurrence was driven mainly by AF type rather than obesity. Within paroxysmal and non-paroxysmal AF, recurrence rates were comparable between patients with BMI < 35 and ≥35 kg/m2 (13.8% vs. 9.1% and 22.9% vs. 23.3%, respectively; log-rank P = 0.925). Severe obesity was not associated with recurrence after multivariable adjustment (HR, 0.86; 95% CI, 0.65-1.14; P = 0.299), with similar findings when BMI was analysed continuously.Conclusion\n\nIn 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.", "abstract_shown": true, "affiliations": [ "Cardiology Department, CHU Clermont-Ferrand, 58 rue Montalembert, Clermont-Ferrand F-63000, France.", "Institut Pascal, Université Clermont Auvergne, CNRS, SIGMA Clermont, 4 avenue Blaise Pascal, TSA 60026 / CS 60026, Aubière Cedex F-63178, France.", "Department of Cardiology, Rouen University Hospital and UNIROUEN, INSERM U1096, Rouen, France.", "Institut de Cardiologie, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France.", "Department of Biostatistics, CHU Clermont-Ferrand, Clermont-Ferrand F-63000, France.", "Department of Cardiology, GHP Ambroise Paré Hartmann, Neuilly-sur-Seine, France.", "Department of Cardiology, Toulouse University Hospital, Toulouse, France.", "Cardiology Department, Grenoble-Alpes University, University Hospital, Grenoble, France.", "Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France.", "Division of Cardiology, European Georges Pompidou Hospital, Paris, France.", "Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France.", "Department of Cardiology, Pôle Santé République, Clermont-Ferrand, France.", "Department of Cardiology, Clinique du Millénaire, Montpellier, France.", "Cardiology Department, Datacoeur Research Team, ETHICS Laboratory, GHICL Hôpital Saint Philibert, Lille, France.", "Cardiac Arrhythmia Department, IHU Liryc, Univ. Bordeaux, INSERM 1045, CHU de Bordeaux, Bordeaux, France.", "Department of Cardiology, Caen University Hospital, Caen, France.", "Department of Cardiology, CHU de Montpellier, Montpellier, France.", "Department of Cardiology, Hôpital de la Croix-Rousse, Lyon, France.", "Department of Cardiology, Institut Arnault Tzanck, Saint-Laurent-du-Var, France.", "Department of Cardiology, CHU de Tours, Tours, France.", "Department of Cardiology, Hôpital Privé du Confluent, Nantes, France.", "Department of Cardiology, Polyclinique Saint-Laurent, Rennes, France.", "Department of Cardiology, CHU de Saint-Étienne, Saint-Étienne, France.", "Department of Cardiology, AP-HP Hôpital Bichat, Paris, France.", "Department of Cardiology, Clinique Saint Augustin, Bordeaux, France.", "Department of Cardiology, Clinique Saint-Pierre, Perpignan, France.", "Department of Cardiology, Polyclinique Reims-Bezannes, Bezannes, France.", "Department of Cardiology, Clinique Victor Pauchet, Amiens, France.", "Department of Cardiology, Clinique Saint-Joseph, Trélazé, France.", "Department of Cardiology, Centre Hospitalier de Pau, Pau, France.", "Department of Cardiology, CHU de Marseille, Marseille, France.", "Department of Cardiology, CHU de Poitiers, Poitiers, France.", "Department of Cardiology, CHU de Limoges, Limoges, France.", "Department of Cardiology, CHU de Lille, Lille, France.", "Department of Cardiology, University Hospital Nancy, Nancy, France." ], "article_type": "research article", "arxiv": null, "author_total": 48, "authors": [ { "affs": [ 0, 1 ], "name": "Grégoire Massoullié", "orcid": "0000-0002-9547-0835" }, { "affs": [ 2 ], "name": "Corentin Chaumont" }, { "affs": [ 3 ], "name": "Mikael Laredo", "orcid": "0000-0002-7326-2656" }, { "affs": [ 4 ], "name": "Bruno Pereira", "orcid": "0000-0003-3778-7161" }, { "affs": [ 5 ], "name": "Olivier Thomas" }, { "affs": [ 6 ], "name": "Philippe Maury", "orcid": "0000-0002-4800-1841" }, { "affs": [ 7 ], "name": "Pascal Defaye", "orcid": "0000-0002-7183-4278" }, { "affs": [ 8 ], "name": "Serge Boveda", "orcid": "0000-0002-1280-7042" }, { "affs": [ 9 ], "name": "Eloi Marijon", "orcid": "0000-0001-7227-3428" }, { "affs": [ 10 ], "name": "William Escande" }, { "affs": [ 11 ], "name": "Antoine Roux", "orcid": "0009-0008-5846-8999" }, { "affs": [ 12 ], "name": "Franck Raczka", "orcid": "0009-0005-4742-5449" }, { "affs": [ 13 ], "name": "Yves Guyomar", "orcid": "0009-0002-6057-6768" }, { "affs": [ 14 ], "name": "Pierre Jaïs", "orcid": "0000-0002-4700-7811" }, { "affs": [ 15 ], "name": "Pierre Ollitrault", "orcid": "0000-0002-2739-1967" }, { "affs": [ 16 ], "name": "Mathieu Granier", "orcid": "0000-0002-0871-4126" }, { "affs": [ 17 ], "name": "Samir Fareh", "orcid": "0009-0009-3539-4680" }, { "affs": [ 18 ], "name": "Hugo Marchand", "orcid": "0009-0007-4477-2765" }, { "affs": [ 19 ], "name": "Bertrand Pierre", "orcid": "0009-0009-5125-5154" }, { "affs": [ 20 ], "name": "Selim Abbey" }, { "affs": [ 21 ], "name": "Antoine Noel", "orcid": "0009-0000-5977-7875" }, { "affs": [ 22 ], "name": "Antoine Da Costa", "orcid": "0000-0003-3302-9988" }, { "affs": [ 23 ], "name": "Fabrice Extramiana", "orcid": "0000-0001-8123-4842" }, { "affs": [ 24 ], "name": "Olivier Cesari" }, { "affs": [ 15 ], "name": "Laure Champ-Rigot", "orcid": "0000-0001-5769-4398" }, { "affs": [ 25 ], "name": "Ziad Khoueiry" }, { "affs": [ 26 ], "name": "Thibault Villemin" }, { "affs": [ 27 ], "name": "Sarah Traullé", "orcid": "0009-0001-9525-4497" }, { "affs": [ 28 ], "name": "Frédéric Treguer", "orcid": "0000-0001-6494-333X" }, { "affs": [ 29 ], "name": "Hugues Bader", "orcid": "0009-0008-0729-5362" }, { "affs": [ 30 ], "name": "Jean-Claude Deharo", "orcid": "0000-0002-1534-3845" }, { "affs": [ 31 ], "name": "Bruno Degand", "orcid": "0000-0003-4878-2075" }, { "affs": [ 32 ], "name": "Benoît Guy-Moyat", "orcid": "0000-0003-3437-9349" }, { "affs": [ 33 ], "name": "Didier Klug", "orcid": "0000-0003-4548-876X" }, { "affs": [ 3 ], "name": "Estelle Gandjbakhch", "orcid": "0000-0002-4846-5021" }, { "affs": [ 5 ], "name": "Alexandre Zhao", "orcid": "0000-0001-8527-7065" }, { "affs": [ 6 ], "name": "Maxime Beneyto", "orcid": "0000-0002-9897-6807" }, { "affs": [ 7 ], "name": "Sandrine Venier", "orcid": "0000-0003-1129-5089" }, { "affs": [ 8 ], "name": "Stéphane Combes", "orcid": "0000-0002-0040-676X" }, { "affs": [ 10 ], "name": "Antoine Lepillier", "orcid": "0000-0001-9757-362X" }, { "affs": [ 11 ], "name": "Marc Mielczarek" }, { "affs": [ 12 ], "name": "Nicolas Clementy", "orcid": "0000-0002-7415-0787" }, { "affs": [ 13 ], "name": "Aymeric Menet", "orcid": "0000-0003-4823-1556" }, { "affs": [ 14 ], "name": "Frédéric Sacher", "orcid": "0000-0001-8348-9320" }, { "affs": [ 34 ], "name": "Christian De Chillou", "orcid": "0000-0002-9025-6821" }, { "affs": [ 0, 1 ], "name": "Romain Eschalier", "orcid": "0000-0003-3183-7084" }, { "affs": [ 2 ], "name": "Frédéric Anselme", "orcid": "0000-0002-2130-9790" }, { "name": "FRANCE-PFA Registry" } ], "bibtex": "https://research.draconitic.com/paper/6apfm2edv5nsr.bib", "cited_by": 0, "doi": "10.1093/europace/euag288", "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13717914/?tool=EBI", "id": "6apfm2edv5nsr", "issns": [ "1099-5129", "1532-2092" ], "landing_url": "https://europepmc.org/article/PMC/PMC13717914", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "AcademicSubjects/MED00200" ], [ "heading", "Clinical Research" ], [ "heading", "Eurheartj/1" ], [ "heading", "Eurheartj/12" ], [ "heading", "Eurheartj/3" ], [ "heading", "Eurheartj/45" ], [ "heading", "Eurheartj/47" ], [ "openalex", "2705|Atrial Fibrillation Management and Outcomes" ] ], "openalex": "W7224551566", "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13717914/pdf/?tool=EBI", "pmcid": "PMC13717914", "pmid": "42954927", "published": "2026-10-01", "publisher": "Oxford University Press", "ris": "https://research.draconitic.com/paper/6apfm2edv5nsr.ris", "sources": [ { "first_seen": "2026-10-31T00:20:39Z", "native_id": "PMC:PMC13717914", "source": "europepmc", "url": "https://europepmc.org/article/PMC/PMC13717914" }, { "first_seen": "2026-11-01T00:20:44Z", "native_id": "MED:42954927", "source": "europepmc", "url": "https://europepmc.org/article/MED/42954927" }, { "first_seen": "2026-11-02T12:22:07Z", "native_id": "PMC13717914", "source": "pmc", "url": "https://doi.org/10.1093/europace/euag288" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2705|Atrial Fibrillation Management and Outcomes", "subfield": "cardiovascular" } ], "title": "Impact of obesity on procedural safety and 1-year outcomes after pulsed-field ablation for atrial fibrillation", "title_text": "Impact of obesity on procedural safety and 1-year outcomes after pulsed-field ablation for atrial fibrillation", "type": "peer-reviewed", "updated_at": "2026-11-02T12:22:07Z", "url": "https://research.draconitic.com/paper/6apfm2edv5nsr", "venue": "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", "versions": [] }