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. 2024 Oct;35(10):2006-2016.
doi: 10.1111/jce.16396. Epub 2024 Aug 13.

Representation of obesity in contemporary atrial fibrillation ablation randomized controlled trials

Danielle Dircks  1 , Eh Khaing  2 , Ahmad Aroudaky  3 , Muaaz Almerstani  3 , Nmair Alziadin  3 , Radha P Kanneganti  3 , James Aguto  3 , Jmaylia Mimms  3 , Chen Jiang  4 , Lluis Mont  5 , Domenico Grieco  6 , Carina Blomstrom-Lundqvist  7   8 , Karapet V Davtyan  9 , Sandeep Prabhu  10 , Peter Kistler  10 , Arash Aryana  11 , Jason G Andrade  12 , Laurent Macle  13 , William Schleifer  3 , Jason Payne  3 , Arthur Easley  3 , Faris Khan  3 , John Windle  3 , Shane Tsai  3 , Daniel Anderson  3 , Gleb Haynatzki  14 , Thoetchai Peeraphatdit  14 , Niyada Naksuk  3
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Representation of obesity in contemporary atrial fibrillation ablation randomized controlled trials

Danielle Dircks et al. J Cardiovasc Electrophysiol. 2024 Oct.

Abstract

Background: The prevalence and impact of obesity on outcomes of atrial fibrillation (AF) ablation randomized controlled trials (RCTs) have not been well studied.

Objective: To examine the proportion of participants with obesity enrolled in RCTs of AF ablation and outcomes of ablation when subgroup analysis of participants with obesity were available.

Methods: We systematically searched PubMed and EMBASE for AF ablation RCTs published between January 1, 2015 to May 31, 2022. When body mass index (BMI) data were available, normal distribution was assumed and a z score was used to estimate the proportion of obesity. Results categorized by BMI or body weight status were reviewed. Authors were contacted for additional information.

Results: Of 148 eligible RCTs with 30174 participants, 144 (97.30%) RCTs did not report the proportion of participants with obesity, while published information regarding BMI was available in 63.51%. Three trials excluded patients based on BMI. Using reported BMI, we estimated the proportion of participants with obesity varied greatly across these trials, ranging from 5.82%-71.9% (median 38.02%, interquartile 29.64%, 49.10%). Patients with obesity were represented in a greater proportion among trials conducted in North America (50.23%) and Asia (44.72%), compared to others (32.16%), p < .001. Subgroup analysis or analysis adjusting for BMI was reported in only 13 (8.78%) RCTs; four (30.77%) of these suggested that BMI or body weight might negatively affect primary outcomes.

Conclusion: Obesity is a common comorbidity among AF patients. However, most AF ablation RCTs underreported the proportion of participants with obesity and its impact on the primary outcomes.

Keywords: atrial fibrillation; body mass index; catheter ablation; obesity; randomized controlled trial.

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