Summary of evidence surrounding preablation and postablation risk-factor modification
| Risk factor | Before the procedure | After the procedure |
|---|---|---|
| Hypertension | Hypertension increases incidence of atrial fibrillation5 Periprocedural renal denervation reduces blood pressure and atrial fibrillation recurrence12 Whether aggressive hypertension management before ablation provides additional benefit in preventing atrial fibrillation recurrences is unclear11 | Hypertension increases postprocedural atrial fibrillation recurrence risk8 Rates of recurrence in patients with controlled hypertension are similar to those of patients with no hypertension9 |
| Diabetes mellitus | Diabetes mellitus increases incidence of atrial fibrillation15 Periprocedural role of sodium-glucose cotransporter 2 inhibitors is unclear | Hemoglobin A1c control reduces atrial fibrillation recurrence18 |
| Obesity | Obesity increases both incidence and severity of atrial fibrillation29,30 Preprocedural weight management, including bariatric surgery, improves success33–35,38 | |
| Obstructive sleep apnea | Continuous positive airway pressure reduces atrial fibrillation recurrence in patients with obstructive sleep apnea43,44 | |
| Metabolic dysfunction–associated steatotic liver disease | Preprocedural management is beneficial46 Role of pharmacotherapy is unclear |