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Peer-reviewedCC BYEuropace : 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

Impact of obesity on clinical outcomes and the treatment effect of catheter ablation in atrial fibrillation: insights from CABANA

  • Jonas Erzeel1,2
  • Sebastiaan Dhont1,2
  • Marnicq van Es1,2
  • Michiel De Wever1,2
  • Evelyne Meekers1,2
  • Hugo Van Herendael1
  • Dieter Nuyens1
  • Maximo Rivero-Ayerza1
  • Laurent Pison1,2
  • Wilfried Mullens1,2
  • Wai Hong Wilson Tang3
  • Pieter Martens1,2
  1. 1Department of Cardiology, Ziekenhuis Oost-Limburg A.V., Genk, Belgium.
  2. 2UHasselt, Faculty of Medicine and Life Sciences, Agoralaan, 3590 Diepenbeek, Belgium / LCRC(-MHU).
  3. 3Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA.
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Abstract

Aims

Obesity and atrial fibrillation (AF) are global epidemics, often co-existing and compounding cardiovascular risk. While catheter ablation has emerged as an effective strategy for rhythm control in symptomatic AF, it remains unclear whether obesity modifies its benefit. This post hoc analysis of the CABANA trial investigates the influence of baseline obesity on clinical outcomes after catheter ablation vs. drug therapy in AF patients.Methods and results

A total of 2170 CABANA participants with available body mass index (BMI) were included. Obesity was defined by BMI ≥ 30 kg/m2, and Class II obesity by BMI ≥ 35 kg/m2. Adverse outcomes, AF recurrence, and functional status were analysed using Cox, mixed-effects, and generalized estimating equation models, assessing treatment-by-obesity interactions. Obese patients exhibited higher comorbidity burden, worse baseline functional status, and more persistent AF compared to non-obese counterparts. Higher BMI was associated with increased cardiovascular hospitalization and a higher New York Heart Association functional class. Catheter ablation significantly reduced the risk of 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. However, patients with Class II obesity or higher had worse absolute outcomes despite similar relative benefits from ablation.Conclusion

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. These findings support a multifaceted approach integrating rhythm control with upstream interventions targeting obesity-related atrial remodelling and comorbidity management.

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Cite

BibTeXRIS
BibTeX
@article{erzeel2026impact,
  title = {{Impact of obesity on clinical outcomes and the treatment effect of catheter ablation in atrial fibrillation: insights from CABANA}},
  author = {Jonas Erzeel and Sebastiaan Dhont and Marnicq van Es and Michiel De Wever and Evelyne Meekers and Hugo Van Herendael and Dieter Nuyens and Maximo Rivero-Ayerza and Laurent Pison and Wilfried Mullens and Wai Hong Wilson Tang and Pieter Martens},
  journal = {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},
  year = {2026},
  month = oct,
  doi = {10.1093/europace/euag293},
  url = {https://europepmc.org/article/PMC/PMC13717916},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Impact of obesity on clinical outcomes and the treatment effect of catheter ablation in atrial fibrillation: insights from CABANA
AU  - Jonas Erzeel
AU  - Sebastiaan Dhont
AU  - Marnicq van Es
AU  - Michiel De Wever
AU  - Evelyne Meekers
AU  - Hugo Van Herendael
AU  - Dieter Nuyens
AU  - Maximo Rivero-Ayerza
AU  - Laurent Pison
AU  - Wilfried Mullens
AU  - Wai Hong Wilson Tang
AU  - Pieter Martens
PY  - 2026
DA  - 2026/10/01
JO  - 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
DO  - 10.1093/europace/euag293
UR  - https://europepmc.org/article/PMC/PMC13717916
AB  - Aims  Obesity and atrial fibrillation (AF) are global epidemics, often co-existing and compounding cardiovascular risk. While catheter ablation has emerged as an effective strategy for rhythm control in symptomatic AF, it remains unclear whether obesity modifies its benefit. This post hoc analysis of the CABANA trial investigates the influence of baseline obesity on clinical outcomes after catheter ablation vs. drug therapy in AF patients.Methods and results  A total of 2170 CABANA participants with available body mass index (BMI) were included. Obesity was defined by BMI ≥ 30 kg/m2, and Class II obesity by BMI ≥ 35 kg/m2. Adverse outcomes, AF recurrence, and functional status were analysed using Cox, mixed-effects, and generalized estimating equation models, assessing treatment-by-obesity interactions. Obese patients exhibited higher comorbidity burden, worse baseline functional status, and more persistent AF compared to non-obese counterparts. Higher BMI was associated with increased cardiovascular hospitalization and a higher New York Heart Association functional class. Catheter ablation significantly reduced the risk of 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. However, patients with Class II obesity or higher had worse absolute outcomes despite similar relative benefits from ablation.Conclusion  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. These findings support a multifaceted approach integrating rhythm control with upstream interventions targeting obesity-related atrial remodelling and comorbidity management.
SN  - 1099-5129
SN  - 1532-2092
ER  -