Impact of obesity on clinical outcomes and the treatment effect of catheter ablation in atrial fibrillation: insights from CABANA
In brief
Ablation reduced AF recurrence across obesity levels, but severe obesity worsened outcomes
In 2,170 CABANA participants, catheter ablation reduced atrial fibrillation recurrence and improved symptoms and functional capacity regardless of obesity status. Obesity did not significantly change ablation's relative effect on cardiovascular hospitalization or death, but patients with class II obesity or higher had worse outcomes overall; the post hoc findings support combining rhythm control with attention to weight and related conditions.
- 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 (Q1)
- Published
- 1 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Jonas Erzeel, Sebastiaan Dhont, Marnicq van Es, Michiel De Wever, Evelyne Meekers, Hugo Van Herendael, et al.
- PMID
- 42954928
- DOI
- 10.1093/europace/euag293
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 1 November 2026): Obesity does not modify ablation benefit
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.