Association between weight loss and outcomes in patients undergoing atrial fibrillation ablation: a systematic review and dose–response meta-analysis

Abstract

Background Obesity is an strong risk factor for atrial fibrillation (AF), and obesity can affect the prognosis of AF. However, the role of weight loss on outcomes after ablation remains unclear. Objectives This study aims to determine the relationship between weight loss and outcomes in patients with AF ablation, as well as the potential dose–response relationship. Methods The Cochrane Library, PubMed, and Embase databases were searched to identify studies that reported a relationship between weight loss and ablation up to August 17, 2021. Relative risks (RRs) were pooled using random-effects models. Results One randomized, open-labeled clinical trial and seven cohort studies involving 1283 patients were included. The mean body mass index of all included studies was over 30 kg/m2. The clinical trial showed a non-significant benefit of weight loss intervention on AF recurrence (Odd risk [OR] = 1.02, 95% confidence interval [CI] 0.70–1.47). Meta-analysis based on observational studies showed that the recurrence rate of AF after ablation was significantly reduced (RR = 0.43, 95% CI 0.22–0.81, I2 = 97%) in relatively obese patients with weight loss compared with the control group. Each 10% reduction in weight was associated with a decreased risk of AF recurrence after ablation (RR = 0.54, 95% CI 0.33–0.88) with high statistical heterogeneity (I2 = 76%). An inverse linear association (Pnon-linearity = 0.27) between AF relapse and increasing weight loss was found. Conclusions Our results first suggest an inverse dose–response association between weight loss and risk of recurrent AF after ablation, with moderate certainty. Graphical Abstract

Metabolic Syndrome and Atrial Fibrillation: Different Entities or Combined Disorders

“…Surgical weight reduction, such as bariatric surgery, has shown superior effects on reducing AF incidence compared to medical treatments [ 119 ]. Even after catheter ablation, maintaining a weight reduction of up to 10% was associated with a 27% reduced likelihood of AF recurrence [ 120 ]. Hypertension and AF frequently coexist, placing patients at a higher risk for complications.…”

Obesity-Related Atrial Fibrillation: Cardiac Manifestation of a Systemic Disease

“…Another observational study showed that 239 morbidly obese patients who underwent bariatric surgery with resultant weight loss prior to AF catheter ablation had a lower rate of AF recurrence than those who did not undergo bariatric surgery [ 109 ]. A meta-analysis of patients with weight loss, either by lifestyle modification or bariatric surgery, showed a dose-response reduction in the frequency of AF recurrence after AF ablation [ 110 ]. Mechanistically, this may be explained by atrial reverse remodeling.…”