{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T12:35:43Z","timestamp":1786624543668,"version":"build-2736575974"},"reference-count":13,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Obesity is a recognized risk factor for atrial fibrillation (AF) and may adversely affect rhythm outcomes after catheter ablation. However, the relationship between body mass index (BMI) and clinically relevant recurrence after cryoballoon pulmonary vein isolation (PVI) remains incompletely defined.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We analyzed a retrospective single\u2010center registry of patients undergoing index cryoballoon PVI for AF between January 2018 and January 2024. Patients with documented BMI between 18.5 and 40\u00a0kg\/m\n 2<\/jats:sup>\n were included. The primary endpoint was rehospitalization for rhythm intervention within two years after index ablation, defined as repeat left atrial ablation or electrical cardioversion after a 90\u2010day blanking period. Time\u2010to\u2010event analyses were performed using Kaplan\u2013Meier estimates, log\u2010rank testing, and Cox proportional hazards regression adjusted for age, sex, and AF type.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 2475 patients were included. Median BMI was 27.1\u00a0kg\/m\n 2<\/jats:sup>\n ; 718 patients had BMI < 25\u00a0kg\/m\n 2<\/jats:sup>\n , 1081 had BMI 25\u201329.9\u00a0kg\/m\n 2<\/jats:sup>\n , and 676 had BMI \u2265 30\u00a0kg\/m\n 2<\/jats:sup>\n . During two\u2010year follow\u2010up, 402 primary endpoint events occurred, including 221 repeat ablations and 181 electrical cardioversions. Kaplan\u2013Meier analysis showed a significantly lower event\u2010free rate in overweight and obese patients compared with normal\u2010weight patients. In the adjusted Cox regression, BMI was independently associated with the primary endpoint, with a 3% relative risk increase per 1\u00a0kg\/m\n 2<\/jats:sup>\n BMI increment. No significant interaction was observed for age, sex, or AF type.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Elevated BMI is independently associated with increased risk of clinically relevant rhythm\u2010related rehospitalization after cryoballoon PVI. These findings support the integration of weight management into comprehensive AF ablation care.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/pace.70394","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T12:07:15Z","timestamp":1786622835000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond a Threshold: Body Mass Index as a Continuous Driver of Repeat Intervention After Atrial Fibrillation Cryoablation"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7606-923X","authenticated-orcid":false,"given":"Lucas","family":"Steffens","sequence":"first","affiliation":[{"name":"Department of Cardiology, Electrophysiology and Rhythmology Krankenhaus Porz am Rhein gGmbH Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yazan","family":"Mohsen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Electrophysiology and Rhythmology Krankenhaus Porz am Rhein gGmbH Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Rottl\u00e4nder","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Electrophysiology and Rhythmology Krankenhaus Porz am Rhein gGmbH Cologne Germany"},{"name":"Department of Cardiology, Faculty of Health, School of Medicine University Witten\/Herdecke Witten Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Horlitz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Electrophysiology and Rhythmology Krankenhaus Porz am Rhein gGmbH Cologne Germany"},{"name":"Department of Cardiology, Faculty of Health, School of Medicine University Witten\/Herdecke Witten Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0885-679X","authenticated-orcid":false,"given":"Florian","family":"St\u00f6ckigt","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Electrophysiology and Rhythmology Krankenhaus Porz am Rhein gGmbH Cologne Germany"},{"name":"Department of Cardiology, Venusberg Campus University Hospital Bonn Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae176"},{"issue":"8","key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1161\/CIR.0000000000001303","article-title":"2025 Heart Disease and Stroke Statistics: A Report of US and Global Data from the American Heart Association","volume":"151","author":"Martin S. S.","year":"2025","journal-title":"Circulation"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735\u20101097(00)00886\u2010X"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.05.012"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.65113"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.032277"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/eci.13499"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.15987"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41569\u2010022\u201000679\u20109"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.03.002"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1602014"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2307291"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2502280"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70394","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70394","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70394","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T12:07:16Z","timestamp":1786622836000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":13,"alternative-id":["10.1111\/pace.70394"],"URL":"https:\/\/doi.org\/10.1111\/pace.70394","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"assertion":[{"value":"2026-06-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pace.70394"}}