Safety and efficacy of high- and very high-power short-duration ablation in overweight and obese patients with atrial fibrillation.

Atrial fibrillation (AF) is a common arrhythmia with increasing prevalence, especially in overweight and obese individuals. Pulmonary vein isolation (PVI) using high-power short-duration (HPSD) and very high-power short-duration (vHPSD) ablation has shown effectiveness, but data on the use of these techniques in obese and overweight patients remain limited. This study aimed to evaluate whether body mass index (BMI) influences procedural characteristics, safety, and clinical outcomes of PVI performed using HPSD and vHPSD ablation in patients with symptomatic AF. We retrospectively analyzed 367 patients (119 obese, 138 overweight, 110 normal weight) who underwent HPSD or vHPSD PVI at Ostalb-Klinikum Aalen between 2019 and 2023. Procedural parameters, complications, and 12-month AF recurrence were assessed across BMI groups. Groups were comparable except for age (normal: 68.2 ± 12, overweight: 68 ± 9.7, obese: 64 ± 10.7; p < 0.01), hypertension (54.6%, 70.3%, 73.1%; p < 0.01) and diabetes (12.7%, 11.6%, 22.7%; p = 0.03). Procedure times, fluoroscopy times, and acute PVI success rates (100%) were similar. Base impedance was significantly higher in overweight (122.8 ± 14.1) and obese (123.9 ± 17.6) than in normal weight patients (113.8 ± 21.7; p < 0.01). AF recurrence rates were similar (normal: 20%, overweight: 18.1%, obese: 20.1%; p = 0.9), with no significant BMI correlation (Spearman = - 0.02). Complications were rare (p = 0.54). HPSD and vHPSD ablation are safe and effective in overweight and obese AF patients, with comparable recurrence rates and outcomes to normal-weight patients. Higher base impedance did not impact recurrence or complications.