Could you describe the variables that influence your decision against or advocating for performing atrial fibrillation/flutter ablations in morbidly obese patients, versus opting for medical therapy and if so, choice of antiarrhythmic agent?

The short answer is yes.

We know extreme obesity will increase procedural complications, including but not limited to anesthesia issues, groin access issues, etc.

We also know the chances of meaningful long-term success in very obese patients are lower than what would be in the trials.

Different EPs...