Impact of pre‐ablation weight loss on the success of catheter ablation for atrial fibrillation

Abstract

Introduction: Obesity is an established risk factor for recurrent atrial fibrillation (AF) after ablation. The impact of pre-procedure weight changes on freedom from AF (FFAF) after ablation in obese and nonobese patients is unknown.Methods: A single-center retrospective cohort study of patients undergoing pulmonary vein isolation was performed. Before ablation, all candidates were encouraged to adopt healthy lifestyle habits according to American Heart Association guidelines, including weight loss, by their physician. The primary endpoint was FFAF through 1-year after completion of the 3-month blanking period.Results: Of the 601 patients (68% male; average age 62.1 ± 10.3 years) included in analysis, 234 patients (38.9%) were obese (body mass index ≥ 30) and 315 (52.4%) had paroxysmal AF. FFAF was observed in 420 patients (69.9%) at 15 months. Percent change in weight that occurred during the year before ablation independently predicted FFAF through 15-months in all patients (adjusted odds ratio = 1.17, 95% confidence interval: 1.11-1.23). Subgroup analyses based on paroxysmal vs persistent AF, presence of obesity, and history of prior ablation were performed. Percent change in weight over the year before ablation was independently associated with FFAF in all subgroups except nonobese patients with persistent AF. Conclusion:Pre-ablation weight loss was associated with FFAF in both obese and nonobese patients. Further studies are needed to define the optimal approach to weight loss before AF ablation.

Impact of obesity on catheter ablation of atrial fibrillation: Patient characteristics, procedural complications, outcomes, and quality of life

“…Importantly, there was a significant decrease in AF burden among all BMI groups; in line with our study findings. On the other hand, several observational studies highlighted the influence of preablation weight loss and risk factor modification in enhancing arrhythmia‐free survival 28–31 . The ARREST‐AF cohort study assessed the impact of physician‐driven risk factor and weight management on AF ablation outcomes.…”

“…On the other hand, several observational studies highlighted the influence of preablation weight loss and risk factor modification in enhancing arrhythmia-free survival. [28][29][30][31] The ARREST-AF cohort study assessed the impact of physician-driven risk factor and weight management on AF ablation outcomes. Among 149 patients with BMI > 27 and at least one cardiac risk factor, 61 patients participated in comprehensive physician-directed risk factor modification including weight loss, lipid management, glycemic control, smoking cessation, and sleep-disordered breathing management.…”

Longitudinal risk of death, hospitalizations for atrial fibrillation, and cardiovascular events following catheter ablation of atrial fibrillation: a cohort study

“…Nevertheless, nearly 50% of patients required hospitalization for AF or flutter and repeat ablation, suggesting that additional measures are required to minimize the AF burden. There are several strategies proven to minimize AF recurrence and improve ablation outcomes such as weight loss, 28 reducing alcohol consumption, 29 and optimal management of AF risk factors like comorbid hypertension, diabetes, and sleep apnoea. 30 Systematic implementation of these strategies may further improve ablation outcomes, decrease the disease burden, and reduce the need of hospital admission or repeat procedures.…”

La enfermera experta en fibrilación auricular

“…Es importante identificar aquellos pacientes con obesidad o AOS para poder establecer un tratamiento adecuado para su control 32 . Por lo tanto, es importante establecer circuitos asistenciales para que los pacientes que cumplan estas características sean valorados por la unidad del sueño 33 o el equipo de cirugía bariátrica ya que su control y mejoría, asegura los resultados positivos de la ablación de FA a largo plazo [34][35][36] .…”