Frontiers in Cardiovascular Medicine · Nov 2, 2026
Association between Elevated Body Mass Index and New-Onset Heart Failure in Patients Undergoing Catheter Ablation for Atrial Fibrillation
By Adham Ramadan, Mohamed Doma, Ghazal Sanadgol et al.
Background: Atrial fibrillation (AF) is the most common arrhythmia and a major contributor to heart failure (HF). While catheter ablation (CA) reduces HF progression, some patients remain at risk for incident HF after ablation. This study aims to analyze the relationship between body mass index (BMI) and new-onset HF in patients undergoing CA for AF. Methods: We retrospectively studied patients from the MGH Research Patient Data Registry who underwent first-time CA for AF from January 2013 to August 2024. The primary outcome was new-onset HF. Cox regression identified independent predictors, and Kaplan-Meier analysis assessed HF-free survival across BMI categories. Results: Among 7,363 patients, 550 (7.5%) developed HF during 3.6±2.9 years of follow-up. HF-free survival declined across increasing BMI categories. At 10 years, HF-free survival was 94.2% for BMI <25 and 86.3% for BMI ≥40. Independent predictors of HF included age >75 years (HR 1.79, 95% CI 1.45-2.22), female sex (HR 1.41, 95% CI 1.16-1.73), hypertension (HR 1.28, 95% CI 1.03-1.59), ischemic heart disease (HR 1.44, 95% CI 1.19-1.74), mitral regurgitation (HR 2.60, 95% CI 2.07-3.27), aortic stenosis (HR 1.97, 95% CI 1.38-2.80), pulmonary hypertension (HR 3.02, 95% CI 2.26-4.05), pulmonary embolism (HR 1.99, 95% CI 1.23-3.21), eGFR <60 (HR 2.51, 95% CI 1.87-3.37), BMI 30-34.99 (HR 1.41, 95% CI 1.08-1.85), BMI 35-39.99 (HR 1.90, 95% CI 1.38-2.62), and BMI ≥40 (HR 2.31, 95% CI 1.56-3.41). Conclusions: Elevated BMI is independently associated with new-onset HF after AF ablation, with risk rising progressively across BMI categories. These patients may warrant continued attention to cardiovascular risk after ablation.