Regional and Sex-Specific Influences on BMI and Catheter Ablation in Paroxysmal Atrial Fibrillation

BackgroundParoxysmal atrial fibrillation (PAF) is an intermittent arrhythmia with self-terminating episodes lasting fewer than seven days. Its development involves multiple factors, with body mass index (BMI) as a key modifiable risk factor. Elevated BMI promotes atrial remodeling and inflammation, increasing PAF susceptibility. Catheter ablation is now central to rhythm control and symptom management. ObjectiveTo evaluate regional and sex-specific patterns in BMI and catheter ablation selection among patients with PAF. Methods84 PAF patients from Georgia (n = 43) and Kazakhstan (n = 41) e retrospectively analyzed. Age, sex, BMI, and ablation type were collected and stratified by center and sex. Inter-sex differences were assessed with t-tests, effect sizes calculated using Cohens d/ h, and BMI distributions evaluated using kernel density estimation. ResultsAnalyses captured 97% of BMI variation. Females were generally older than males (d = 0.55), particularly in Kazakhstan (d = 0.70), while BMI differences were small and not statistically significant. Cryoablation was preferred overall (16% higher), with the largest sex disparity in Kazakhstan (42.9% higher in males); Georgia showed slight RFA preference in females (8.3%). ConclusionThis study of PAF patients in Kazakhstan and Georgia reveals regional- and sex-specific variations in age, BMI, and ablation selection. We highlight the need for tailored risk assessment, early interventions, and awareness of potential clinical biases to ensure equitable care.