Association between weight loss and outcomes in patients undergoing atrial fibrillation ablation: A systematic review and dose-response meta

Objectives: This study aims to determine the relationship between weight loss and outcomes in patients with atrial fibrillation (AF) ablation, as well as the potential dose-response relationship. Background: Obesity is an independent risk factor for AF, and obesity can affect the prognosis of AF. However, the role of weight loss on outcomes after ablation remains unclear. Methods: : The Cochrane Library, PubMed, and Embase databases were searched to identify studies that reported a relationship between weight loss and ablation up to August 17, 2021. Relative risks (RRs) were pooled using random-effects models. Results: : One randomized, open-labeled clinical trial and seven cohort studies involving 1150 patients were included. The mean body mass index of all included studies was over 30 kg/m2. The clinical trial showed nonsignificant benefit of weight loss intervention on AF recurrence (odd risk=1.02, 95% confidence interval [CI]: 0.70-1.47). Meta-analysis based on observational studies showed that the recurrence rate of AF after ablation was significantly reduced (RR=0.43, 95% CI: 0.22-0.81, I 2 =97%) in relatively obesity patients with weight loss compared with the control group (morbidly obese patients without weight change). Each 10% reduction in weight was associated with a decreased risk of AF recurrence after ablation (RR=0.54, 95% CI: 0.33-0.88) with high statistical heterogeneity (I 2 =76%). An inverse linear association (P non-linearity =0.27) between AF relapse and increasing weight loss was found. Conclusions: : Our results first suggest an inverse dose-response association between weight loss in risk of recurrent AF after ablation in obese patients.