Abstract Body (Do not enter title and authors here): Background
Obesity is considered a significant risk factor for numerous cardiovascular conditions due to its effects on cardiac structure and function. The prevalence of atrial fibrillation (AF) is elevated among patients with obesity due to the dysregulation of several mechanisms. Weight loss has been shown to reverse cardiac remodeling, leading to a lower recurrence of AF despite the better prognosis in obese patients described as the obesity paradox.

Methods
We utilized the National Inpatient Sample 2016-2019 to extract patients ≥18 years of age admitted with AF as the primary diagnosis based on ICD 10 codes. We performed univariate and multivariate regression analysis for known coronary risk factors. We divided patients based on their body mass index (BMI), and our primary outcomes were determining the odds of electrical cardioversion (ECV) and cardiac ablation (CA) due to AF.

Results
The analysis included 1,625,809 weighted patients. Patients include underweight (6.66%), normal BMI (4.03), overweight (6.51%), obesity class I (20.65%), obesity class II (21.45%), and obesity class III (40.7).

After multivariate regression analysis, patients with obesity class I, II, or III had higher odds of ECV, irrespectively of coronary risk factors (OR 1.3, 95% CI 1.25-1.37, OR 1.3, 95% CI 1.32-1.43, OR 1.3, 95% CI1.29-1.38, respectively, with statistically significant P values). However, underweight or normal BMI patients had fewer odds of ECV (OR 0.5 95%CI 0.49-0.61 and OR 0.6 95%CI 0.58-0.74, respectively, with P values <0.001). Meanwhile, there was no statistical significance between a BMI and the odds of CA.

Conclusion
Our study highlights the significant impact of BMI on managing atrial fibrillation, particularly regarding electrical cardioversion (ECV). Patients in higher BMI categories (obesity class I, II, and III) demonstrated increased odds of undergoing ECV, suggesting that obesity may influence treatment approaches and outcomes in AF management. Interestingly, BMI did not affect the likelihood of cardiac ablation (CA), indicating a more complex relationship between body weight and AF treatment modalities that warrants further investigation. These findings underscore the importance of personalized treatment strategies to optimize outcomes, with a focus on weight management.