Abstract
Abstract Background Paroxysmal 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. Objective To evaluate regional and sex-specific patterns in BMI and catheter ablation selection among patients with PAF. Methods 84 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 Cohen’s d/ h, and BMI distributions evaluated using kernel density estimation. Results Analyses 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%). Conclusion This 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.