Table 1_BMI, race and AF recurrence post ablation: a meta-analysis and systematic review.docx

AimsObesity increases atrial fibrillation (AF) risk, but it remains unclear whether this association can be extrapolated to AF patients who undergoing pulmonary vein isolation (PVI), and whether there are racial differences. This study aims to explore the role and interaction of body mass index (BMI) and racial factors in the risk of AF recurrence post PVI.
MethodsA systematic search was conducted in PubMed, Web of Science, Engineering Index, Wan Fang database, CNKI, and relevant meta-analyses from database inception to May 19, 2025. Standardized data extraction was performed in accordance with the Meta-analysis of Observational Studies in Epidemiology Reporting Guidelines. Primary outcome was the recurrence of AF post PVI. Secondary outcomes included procedural complications, and echocardiographic parameters.
ResultsFinally, 26 studies involving 35,237 individuals were included. The results showed a linear positive correlation between BMI and the risk of AF recurrence post PVI. For every 5-units increase in BMI, the recurrence risk of AF increased by 9%. Subgroup analysis indicated that obese Europeans had a 9% higher recurrence risk (P < 0.001), obese North Americans had a 14% higher recurrence risk (P < 0.001), and Asians had the highest increase in recurrence risk, reaching 37% (P < 0.001). Meta-regression analysis suggested that racial differences were potentially related to the strength of the association between BMI and AF recurrence (P = 0.033). Risk factor analysis identified enlarged left atrial diameter as a potential risk factor contributing to the recurrence of AF (P = 0.021). No statistically significant difference in surgical complications risk was observed between obese and non-obese populations (P = 0.083).
ConclusionOur findings confirm a linear positive correlation between BMI and the risk of AF recurrence post PVI. An enlarged left atrial diameter may be one potential mechanisms underlying AF recurrence. Furthermore, significant racial disparities were identified in AF recurrence risk, with Asian patients showing a significantly higher recurrence risk than European and American patients.
Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024496463, PROSPERO CRD42024496463.