Influence of body mass index on recurrence and quality of life in atrial fibrillation patients after catheter ablation: a meta-analysis and systematic review

Abstract

Background: Accumulating evidence has demonstrated that overweight and obesity, expressed as high body mass index (BMI), are associated with the development of atrial fibrillation (AF) and quality of life (QoL) in AF patients. However, the role of high BMI as a risk factor for prognosis and QoL in AF patients undergoing ablation remains controversial.

Hypothesis: We hypothesized that elevated BMI was correlated with AF recurrence and QoL after an ablative procedure.

Methods: We performed a comprehensive search of PubMed, EMBASE, and the Cochrane Library. Studies were included if they investigated the association of BMI with AF recurrence and QoL after ablation.

Results: Of the 151 articles identified, 12 studies that enrolled 3286 individuals met the inclusion criteria. Overall, compared with normal-BMI patients, AF recurrence occured more frequently in high-BMI patients after ablation (odds ratio: 1.32, 95% confidence interval: 1.17-1.5, P < 0.001). However, the pooled esimate of odds ratio adjusted for multiple confounders did not reach significance. The summary weighted mean difference of BMI between patients with and without recurrence was 0.43 (95% confidence interval: 0.05-0.81, P = 0.027). In addition, QoL scores were significantly lower in high-BMI than in normal-BMI patients before the ablative procedure, whereas the gap of QoL between normal-BMI and high-BMI groups was decreased at follow-up.

Conclusions: Results of this meta-analysis suggest 2 points, namely that the tight association between overweight/obesity and AF recurrence after ablation may be partly due to other concomitant conditions, and that impaired QoL in high-BMI groups is significantly improved after ablation.

Figure 1

Study flow chart of meta‐analysis. Abbreviations: AF, atrial fibrillation; BMI, body mass index; QOL, quality of life.

Figure 2

Pooled OR for the risk of AF recurrence in (A) high‐BMI and normal‐BMI groups, and (B) overweight and obese groups. Abbreviations: AF, atrial fibrillation; BMI, body mass index; CI, confidence interval; OR, odds ratio.

Figure 3

Comparison of BMI between recurrence and nonrecurrence group in included studies. Abbreviations: BMI, body mass index; CI, confidence interval; WMD, weighted mean difference.

Figure 4

Summary HR for composite of AF recurrence between high‐BMI and normal‐BMI groups. Confounding factors adjusted for in 4 studies are documented. Note that variables named baseline characteristics indicate those listed in Table 1. Abbreviations: AF, atrial fibrillation; BMI, body mass index; BNP, brain natriuretic peptide; CI, confidence interval; ERAF, early recurrence of atrial fibrillation; HR, hazard ratio; MMP‐2, matrix metalloproteinase‐2; WBC, white blood cell.