The Management of Obesity Before Catheter Ablation of AF: The Missing Piece?

Obesity independently increases AF risk and negatively affects the outcomes of catheter ablation. This review examines the relationship between obesity and AF, focusing on structural and electrical remodelling. Multiple studies demonstrate worse ablation outcomes in patients with obesity. Pre-ablation weight loss improves outcomes and maintaining weight loss post-ablation is equally important. Risk factor modification programmes show promise, however they require a large investment in resources. Less intensive strategies focusing on diet and exercise have shown mixed results. Glucagon-like peptide-1 receptor agonists have been identified as potential adjunct therapies. They have multiple effects, including preferential reduction of epicardial adipose tissue and an anti-inflammatory action. Further research is needed to establish their efficacy in improving ablation outcomes. This review highlights the importance of weight management in AF treatment and suggests potential monitoring strategies using cardiac imaging. Future studies may shift the paradigm for the management of AF patients with obesity who are undergoing ablation.