Cryoballoon Pulmonary Vein Isolation in Obese Patients with Atrial Fibrillation Compared to Non-Obese Counterparts: A Meta-Analysis

doi:10.3390/biomedicines13020298

Review

. 2025 Jan 25;13(2):298.

doi: 10.3390/biomedicines13020298.

Cryoballoon Pulmonary Vein Isolation in Obese Patients with Atrial Fibrillation Compared to Non-Obese Counterparts: A Meta-Analysis

Dimitrios A Vrachatis^{1

2}, Konstantinos A Papathanasiou³, Dimitrios Kazantzis⁴, Ioannis Anagnostopoulos¹, Maria Kousta¹, Sotiria G Giotaki¹, Gerasimos Deftereos¹, Vaia Lambadiari⁵, George Giannopoulos⁶, Efthimia K Basdra^{1

7}, Theodore G Papaioannou², Gerasimos Siasos⁸, Spyridon Deftereos^{1

3}

Affiliations

¹ Eugenideio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece.
² Department of Biomedical Engineering, National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece.
³ Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 12462 Athens, Greece.
⁴ NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK.
⁵ Second Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 12462 Athens, Greece.
⁶ Third Department of Cardiology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
⁷ Department of Biological Chemistry, National and Kapodistrian University of Athens, Medical School, 12462 Athens, Greece.
⁸ Third Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece.

PMID: 40002711
PMCID: PMC11852532
DOI: 10.3390/biomedicines13020298

Review

Cryoballoon Pulmonary Vein Isolation in Obese Patients with Atrial Fibrillation Compared to Non-Obese Counterparts: A Meta-Analysis

Dimitrios A Vrachatis et al. Biomedicines. 2025.

. 2025 Jan 25;13(2):298.

doi: 10.3390/biomedicines13020298.

Authors

Affiliations

¹ Eugenideio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece.
² Department of Biomedical Engineering, National and Kapodistrian University of Athens, Medical School, 11527 Athens, Greece.
³ Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 12462 Athens, Greece.
⁴ NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK.
⁵ Second Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 12462 Athens, Greece.
⁶ Third Department of Cardiology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
⁷ Department of Biological Chemistry, National and Kapodistrian University of Athens, Medical School, 12462 Athens, Greece.
⁸ Third Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece.

PMID: 40002711
PMCID: PMC11852532
DOI: 10.3390/biomedicines13020298

Abstract

Introduction: Obesity is an important risk factor for atrial fibrillation (AF) development. Data on cryoballoon ablation (CBA) outcomes in obese patients have so far been scarce. We reviewed the existing literature to compare the efficacy and safety of CBA in obese versus non-obese AF patients. Methods: A systematic literature search was conducted for studies comparing clinical outcomes (arrhythmia recurrence and/or procedural data and/or safety outcomes) between obese and non-obese patients undergoing CBA for AF. Statistical pooling was performed according to a random-effects model with generic inverse-variance weighting of relative risks (RRs) and standardised mean differences (SMDs) computing risk estimates with 95% confidence intervals (CIs). Results: Obese and non-obese patients had comparable arrhythmia recurrence rates (normal versus overweight, RR = 0.95, 95% CI: 0.82-1.11, p = 0.55, I²% = 91%; normal versus class I obesity, RR = 0.97, 95% CI: 0.82-1.13, p = 0.68, I²% = 87%; normal versus class II obesity, RR = 0.98, 95% CI: 0.91-1.07, p = 0.29, I²% = 65%). Procedure time was marginally increased in obese patients compared to non-obese counterparts (normal versus overweight, SMD = 0.05, 95% CI: -0.15-0.26, p = 0.62, I²% = 74%; normal versus class I obesity, SMD = 0.10, 95% CI: -0.00-0.19, p = 0.06, I²% = 2%; overweight versus class I obesity, SMD = 0.11, 95% CI: 0.01-0.21, p = 0.048, I²% = 25%). Regarding radiation exposure, fluoroscopy time was increased in patients with class I obesity compared to normal-weight or overweight patients and dose area product was also increased in obese patients compared to non-obese patients. Lastly, the risk of complications did not differ between obese and non-obese patients. Statistical heterogeneity and the small number of patients included are the main limitations of this study. Conclusion: CBA seems to be effective for obese patients suffering from AF, featuring also similar safety outcomes with non-obese individuals. Radiation exposure was increased in obese patients.

Keywords: arrhythmia recurrence; atrial fibrillation; body mass index; catheter ablation; obesity; radiation exposure.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

**Figure 2**
Arrhythmia-free survival: (A) normal BMI versus overweight patients, (B) normal BMI versus class I obesity patients, (C) overweight versus class I obesity patients [22,23,24,26,27,28,29].

**Figure 3**
Procedure time: (A) normal BMI versus overweight patients, (B) normal BMI versus class I obesity patients, (C) overweight versus class I obesity patients [22,23,24,25,29].

**Figure 4**
Fluoroscopy time: (A) normal BMI versus overweight patients, (B) normal BMI versus class I obesity patients, (C) overweight versus class I obesity patients [22,23,24,26,28,29].

**Figure 5**
Dose area product: (A) normal BMI versus overweight patients, (B) normal BMI versus class I obesity patients, (C) overweight versus class I obesity patients [22,23,25,26,28,29].

**Figure 6**
Complications: (A) normal BMI versus overweight patients, (B) normal BMI versus class I obesity patients, (C) overweight versus class I obesity patients [22,23,24,26,27].

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References

1. Kornej J., Börschel C.S., Benjamin E.J., Schnabel R.B. Epidemiology of Atrial Fibrillation in the 21st Century. Circ. Res. 2020;127:4–20. doi: 10.1161/CIRCRESAHA.120.316340. - DOI - PMC - PubMed
1. Chatterjee N.A., Giulianini F., Geelhoed B., Lunetta K.L., Misialek J.R., Niemeijer M.N., Rienstra M., Rose L.M., Smith A.V., Arking D.E., et al. Genetic Obesity and the Risk of Atrial Fibrillation: Causal Estimates from Mendelian Randomization. Circulation. 2017;135:741–754. doi: 10.1161/CIRCULATIONAHA.116.024921. - DOI - PMC - PubMed
1. Wang Q., Richardson T.G., Sanderson E., Tudball M.J., Ala-Korpela M., Davey Smith G., Holmes M.V. A phenome-wide bidirectional Mendelian randomization analysis of atrial fibrillation. Int. J. Epidemiol. 2022;51:1153–1166. doi: 10.1093/ije/dyac041. - DOI - PMC - PubMed
1. Wong C.X., Sullivan T., Sun M.T., Mahajan R., Pathak R.K., Middeldorp M., Twomey D., Ganesan A.N., Rangnekar G., Roberts-Thomson K.C., et al. Obesity and the Risk of Incident, Post-Operative, and Post-Ablation Atrial Fibrillation: A Meta-Analysis of 626,603 Individuals in 51 Studies. JACC. Clin. Electrophysiol. 2015;1:139–152. doi: 10.1016/j.jacep.2015.04.004. - DOI - PubMed
1. Aune D., Sen A., Schlesinger S., Norat T., Janszky I., Romundstad P., Tonstad S., Riboli E., Vatten L.J. Body mass index, abdominal fatness, fat mass and the risk of atrial fibrillation: A systematic review and dose–response meta-analysis of prospective studies. Eur. J. Epidemiol. 2017;32:181–192. doi: 10.1007/s10654-017-0232-4. - DOI - PMC - PubMed

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[1] Kornej J., Börschel C.S., Benjamin E.J., Schnabel R.B. Epidemiology of Atrial Fibrillation in the 21st Century. Circ. Res. 2020;127:4–20. doi: 10.1161/CIRCRESAHA.120.316340. - DOI - PMC - PubMed

[2] Kornej J., Börschel C.S., Benjamin E.J., Schnabel R.B. Epidemiology of Atrial Fibrillation in the 21st Century. Circ. Res. 2020;127:4–20. doi: 10.1161/CIRCRESAHA.120.316340. - DOI - PMC - PubMed

[3] Chatterjee N.A., Giulianini F., Geelhoed B., Lunetta K.L., Misialek J.R., Niemeijer M.N., Rienstra M., Rose L.M., Smith A.V., Arking D.E., et al. Genetic Obesity and the Risk of Atrial Fibrillation: Causal Estimates from Mendelian Randomization. Circulation. 2017;135:741–754. doi: 10.1161/CIRCULATIONAHA.116.024921. - DOI - PMC - PubMed

[4] Chatterjee N.A., Giulianini F., Geelhoed B., Lunetta K.L., Misialek J.R., Niemeijer M.N., Rienstra M., Rose L.M., Smith A.V., Arking D.E., et al. Genetic Obesity and the Risk of Atrial Fibrillation: Causal Estimates from Mendelian Randomization. Circulation. 2017;135:741–754. doi: 10.1161/CIRCULATIONAHA.116.024921. - DOI - PMC - PubMed

[5] Wang Q., Richardson T.G., Sanderson E., Tudball M.J., Ala-Korpela M., Davey Smith G., Holmes M.V. A phenome-wide bidirectional Mendelian randomization analysis of atrial fibrillation. Int. J. Epidemiol. 2022;51:1153–1166. doi: 10.1093/ije/dyac041. - DOI - PMC - PubMed

[6] Wang Q., Richardson T.G., Sanderson E., Tudball M.J., Ala-Korpela M., Davey Smith G., Holmes M.V. A phenome-wide bidirectional Mendelian randomization analysis of atrial fibrillation. Int. J. Epidemiol. 2022;51:1153–1166. doi: 10.1093/ije/dyac041. - DOI - PMC - PubMed

[7] Wong C.X., Sullivan T., Sun M.T., Mahajan R., Pathak R.K., Middeldorp M., Twomey D., Ganesan A.N., Rangnekar G., Roberts-Thomson K.C., et al. Obesity and the Risk of Incident, Post-Operative, and Post-Ablation Atrial Fibrillation: A Meta-Analysis of 626,603 Individuals in 51 Studies. JACC. Clin. Electrophysiol. 2015;1:139–152. doi: 10.1016/j.jacep.2015.04.004. - DOI - PubMed

[8] Wong C.X., Sullivan T., Sun M.T., Mahajan R., Pathak R.K., Middeldorp M., Twomey D., Ganesan A.N., Rangnekar G., Roberts-Thomson K.C., et al. Obesity and the Risk of Incident, Post-Operative, and Post-Ablation Atrial Fibrillation: A Meta-Analysis of 626,603 Individuals in 51 Studies. JACC. Clin. Electrophysiol. 2015;1:139–152. doi: 10.1016/j.jacep.2015.04.004. - DOI - PubMed

[9] Aune D., Sen A., Schlesinger S., Norat T., Janszky I., Romundstad P., Tonstad S., Riboli E., Vatten L.J. Body mass index, abdominal fatness, fat mass and the risk of atrial fibrillation: A systematic review and dose–response meta-analysis of prospective studies. Eur. J. Epidemiol. 2017;32:181–192. doi: 10.1007/s10654-017-0232-4. - DOI - PMC - PubMed

[10] Aune D., Sen A., Schlesinger S., Norat T., Janszky I., Romundstad P., Tonstad S., Riboli E., Vatten L.J. Body mass index, abdominal fatness, fat mass and the risk of atrial fibrillation: A systematic review and dose–response meta-analysis of prospective studies. Eur. J. Epidemiol. 2017;32:181–192. doi: 10.1007/s10654-017-0232-4. - DOI - PMC - PubMed

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Cryoballoon Pulmonary Vein Isolation in Obese Patients with Atrial Fibrillation Compared to Non-Obese Counterparts: A Meta-Analysis

Affiliations

Cryoballoon Pulmonary Vein Isolation in Obese Patients with Atrial Fibrillation Compared to Non-Obese Counterparts: A Meta-Analysis

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