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Weight Management and Atrial Fibrillation | Journal Scan
Study Questions:
Is weight loss associated with a reduced atrial fibrillation (AF) burden?
Methods:
The study group consisted of 355 patients with symptomatic AF (approximately 50% paroxysmal/persistent) and a body mass index (BMI) ≥27 kg/m2. The importance of weight loss and management of associated cardiovascular conditions was communicated to all patients. They were also given the option to attend a physician-led weight loss clinic or to participate in a self-managed weight loss program. The degree of weight loss was prespecified as ≥10% (Group 1), 3-9% (Group 2), and <3% (Group 3). The effect of weight fluctuation (defined as ≥1% change in weight, in either direction, between two consecutive annual follow-up visits) was analyzed. AF was managed by physicians blinded to proceedings in the weight loss clinic. Arrhythmia burden was assessed by a combination of symptoms, electrocardiogram, and 7-day Holter monitoring.
Results:
The mean follow-up was approximately 4 years. AF burden and symptom scores were lower in patients in group 1 versus those in groups 2 and 3 (p < 0.001). Arrhythmia-free survival (either with medication or ablation) was greater in group 1 versus other groups (p < 0.001). On multivariable analysis, weight loss ≥10% was associated with a greater likelihood of arrhythmia-free survival, whereas weight fluctuation >5% was associated with an increased risk of arrhythmia recurrence. Evidence of reverse remodeling of cardiac structure (left atrial volume, interventricular thickness, and others) was also evident. Patients who were not treated with rhythm-controlling drugs or ablation also noted an improvement in arrhythmia burden.
Conclusions:
The authors concluded that sustained weight loss is associated with a reduction in AF burden.
Perspective:
Obesity is associated with an abnormal atrial substrate and predisposes to AF. This study confirms that weight management in a dedicated clinic is associated with improved arrhythmia outcomes. It is important for physicians to emphasize the importance of secondary prevention of AF to their patients, even after catheter ablation, to minimize the risk of arrhythmia recurrence and redo procedures.
Keywords: ACC Annual Scientific Session, Atrial Fibrillation, Arrhythmias, Cardiac, Body Mass Index, Body Weight, Catheter Ablation, Electrocardiography, Obesity, Weight Loss, Weight Reduction Programs, Primary Prevention, Secondary Prevention
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