Successful atrial fibrillation ablation following bariatric surgery in Japanese patients with extreme obesity.

Obesity is a significant risk factor for the development and progression of atrial fibrillation (AF) and is associated with poor outcomes following AF ablation. We present two compelling cases of extremely obese Japanese patients with long-standing persistent AF who underwent laparoscopic sleeve gastrectomy (LSG) prior to successful radiofrequency catheter ablation (RFCA). Both patients maintained sinus rhythm for over 4.5 years post-RFCA, with notable improvements in cardiac parameters, such as reduced left atrial size, and favorable metabolic profiles, including improved glycemic control and decreased N-terminal pro-B-type natriuretic peptide levels. These cases underscore the crucial benefits of weight reduction strategies, particularly bariatric surgery, as a preparatory intervention for AF ablation in this challenging patient population. While severe obesity (body mass index ≥35 kg/m Learning objective: This case report highlights the significant impact of bariatric surgery on improving catheter ablation outcomes for atrial fibrillation (AF) in extremely obese patients. It demonstrates how substantial weight reduction can lead to favorable cardiac remodeling and metabolic improvements, enhancing long-term rhythm control after ablation. We emphasize the growing importance of a multidisciplinary approach that integrates weight management into the overall treatment strategy for obese AF patients.