Effect of Weight Reduction and Cardiometabolic Risk Factor Management on Symptom Burden and Severity in Patients With Atrial Fibrillation

Abstract

IMPORTANCE Obesity is a risk factor for atrial fibrillation. Whether weight reduction and cardiometabolic risk factor management can reduce the burden of atrial fibrillation is not known. OBJECTIVE To determine the effect of weight reduction and management of cardiometabolic risk factors on atrial fibrillation burden and cardiac structure. DESIGN, SETTING, AND PATIENTS Single-center, partially blinded, randomized controlled study conducted between June 2010 and December 2011 in Adelaide, Australia, among overweight and obese ambulatory patients (N = 150) with symptomatic atrial fibrillation. Patients underwent a median of 15 months of follow-up. INTERVENTIONS Patients were randomized to weight management (intervention) or general lifestyle advice (control). Both groups underwent intensive management of cardiometabolic risk factors. MAIN OUTCOMES AND MEASURES The primary outcomes were Atrial Fibrillation Severity Scale scores: symptom burden and symptom severity. Scores were measured every 3 months from baseline to 15 months. Secondary outcomes performed at baseline and 12 months were total atrial fibrillation episodes and cumulative duration measured by 7-day Holter, echocardiographic left atrial area, and interventricular septal thickness. RESULTS Of 248 patients screened, 150 were randomized (75 per group) and underwent follow-up. The intervention group showed a significantly greater reduction, compared with the control group, in weight (14.3 and 3.6 kg, respectively; P < .001) and in atrial fibrillation symptom burden scores (11.8 and 2.6 points, P < .001), symptom severity scores (8.4 and 1.7 points, P < .001), number of episodes (2.5 and no change, P = .01), and cumulative duration (692-minute decline and 419-minute increase, P = .002). Additionally, there was a reduction in interventricular septal thickness in the intervention and control groups (1.1 and 0.6 mm, P = .02) and left atrial area (3.5 and 1.9 cm 2 , P = .02). CONCLUSIONS AND RELEVANCE In this study, weight reduction with intensive risk factor management resulted in a reduction in atrial fibrillation symptom burden and severity and in beneficial cardiac remodeling. These findings support therapy directed at weight and risk factors in the management of atrial fibrillation.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Identyfikacja takich stanów, ich prewencja oraz leczenie są ważnym sposobem zapobiegania AF i zmniejszania obciążeń związanych z tą arytmią. Znajomość tych czynników oraz ich leczenia jest więc ważna dla optymalnego postępowania u pacjentów z AF [203,204]. [215][216][217].…”

“…Intensywna redukcja masy ciała w połączeniu z leczeniem innych czynników ryzyka sercowo-naczyniowego (związana ze zmniejszeniem masy ciała o ok. 10-15 kg) prowadziła do ograniczenia częstości występowania nawrotów AF oraz objawów klinicznych w porównaniu z ogólnym poradnictwem u otyłych pacjentów z AF [203,204,296]. Poprawa wydolności układów sercowo-naczyniowego i oddechowego może spowodować dalsze zmniejszenie obciążeń wynikających z AF u otyłych pacjentów z tą arytmią [297].…”

Atrial remodelling in heart failure: recent developments and relevance for heart failure with preserved ejection fraction

“…Weight reduction with intensified risk factor management induces reverse atrial remodelling and reduces AF prevalence 100. Exercise training was also associated with a reduction in LA volume in HFpEF 101…”

Defining the major health modifiers causing atrial fibrillation: a roadmap to underpin personalized prevention and treatment

“…47,48 , and physical activity reduction might contribute to the prevention of AF in athletes 49 . Specialized, nurse-led, AF clinics improve guideline adherence 50 , and might also prove valuable in targeting risk factors, such as weight reduction, in identifying warning signs and symptoms, and by raising patient awareness of their disease.…”

“…The profound and swift effects of weight loss on AF 47,48 cannot be explained by long-term cardiovascular protection 83 . Obesity not only creates atrial fibrosis 84 , but also increases epicardial fat 84,85 .…”