Impact of weight loss on ablation outcome in obese patients with longstanding persistent atrial fibrillation

Mohanty, Sanghamitra; Mohanty, Prasant; Natale, Veronica; Trivedi, Chintan; Gianni, Carola; Burkhardt, J. David; Sánchez, Javier; Horton, Rodney; Gallinghouse, G. Joseph; Hongo, Richard; Beheiry, Salwa; Al‐Ahmad, Amin; Biase, Luigi Di

doi:10.1111/jce.13394

Cited by 54 publications

(64 citation statements)

References 25 publications

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“…Another possible explanation for the findings of the current study vis‐à‐vis the Australian experience may be the differences in the patient population. The mean body mass index (BMI) of patients who were included in those studies was approximately 32, which is significantly lower than the BMI (∼ 37) of patients enrolled in the current series . Although it is commendable that all patients who enrolled in the intervention arm of this study were able to achieve and sustain ≥10% weight loss leading up to the ablation, given the severity of obesity, perhaps a greater weight loss over a longer period may have shown different results?…”

contrasting

confidence: 75%

Weight loss in obese patients with longstanding persistent atrial fibrillation undergoing catheter ablation: Is it worth the trouble?

Dixit

Yaeger

2017

Cardiovasc electrophysiol

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Disclosures: None. K E Y W O R D S : atrial fibrillation, catheter ablation, longstanding persistent atrial fibrillation, obesity, weight loss Atrial fibrillation (AF) is the most common cardiac rhythm disorder, impacting over 33 million people worldwide. 1 Besides age, there are several other risk factors that are associated with this condition. These include male gender, obesity, sleep apnea, hypertension, excess alcohol use, etc. Obesity, in particular, has been found to be a strong and independent predictor of AF. 2 Hence, there is growing interest in developing strategies to address this and other common risk factors in the AF population. The first comprehensive attempt to address multiple risk factors in AF patients was made by Pathak et al. in a physician-directed out patient clinic model. 3 Using this approach, these investigators were able to modify favorably obesity, sleep apnea, hypertension, diabetes, cholesterol, alcohol consumption, and smoking in their AF patients, which translated into improved AF ablation outcomes.

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contrasting

confidence: 75%

Weight loss in obese patients with longstanding persistent atrial fibrillation undergoing catheter ablation: Is it worth the trouble?

Dixit

Yaeger

2017

Cardiovasc electrophysiol

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“…In patients with long-standing persistent AF with morbid obesity, a study evaluated the impact of weight loss in 90 patients 49. While there was significant weight loss over 12 months, they were unable to demonstrate improvement in symptoms, AF burden and ablation outcomes.…”

Section: Additional Studies Addressing Risk Factors For Afmentioning

confidence: 99%

Lifestyle modifications for treatment of atrial fibrillation

Middeldorp

Ariyaratnam

Lau

et al. 2019

Heart

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The management of atrial fibrillation (AF) has focused on anticoagulation, rhythm control and ventricular rate control. Recently, a fourth pillar of AF management has been incorporated recognising the importance of risk factor management (RFM). There are several risk factors that contribute to the development and progression of AF, these include traditional risk factors such as age, hypertension, heart failure, diabetes and valvular heart disease. However, increasingly it is recognised that obesity, sleep apnoea, hyperlipidaemia, smoking, alcohol, physical inactivity, genetics, aortic stiffness are associated with the development of AF. Importantly, several of these risk factors are modifiable. We have seen the evolution of RFM programmes which have demonstrated promising results. Indeed, the evidence is now so compelling that major clinical guidelines strongly advocate that aggressive treatment of these risk factors as a key component of AF management. Patients with AF who comprehensively managed their risk factors demonstrate greater reduction in symptoms, AF burden, more successful ablations and improved outcomes with greater AF freedom. In this article, we will review the evidence for the association between cardiac risk factors and AF and assess the burgeoning evidence for improved AF outcomes associated with aggressive cardiac RFM.

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“…A similar lack of improvement in catheter ablation outcomes among patients with AF participating in RFM has been previously shown. Despite achieving ≥10% weight loss in patients with persistent AF undergoing catheter ablation, Mohanty et al 18 did not find significantly improved long‐term arrhythmia‐free outcomes in these patients vs a control group. Similarly, other studies have shown no difference in ablation success rates among lean, overweight, and obese patients with AF 19,20 .…”

Section: Discussionmentioning

confidence: 92%

Impact of a nurse‐led limited risk factor modification program on arrhythmia outcomes in patients with atrial fibrillation undergoing catheter ablation

Yaeger

Keenan

Cash

et al. 2020

Cardiovasc electrophysiol

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Background:We have previously demonstrated the feasibility of a nurse-led risk factor modification (RFM) program for improving weight loss and obstructive sleep apnea (OSA) care among patients with atrial fibrillation (AF).Objective: We now report its impact on arrhythmia outcomes in a subgroup of patients undergoing catheter ablation.Methods: Participating patients with obesity and/or need for OSA management (high risk per Berlin Questionnaire or untreated OSA) underwent in-person consultation and monthly telephone calls with the nurse for up to 1 year. Arrhythmias were assessed by office ECGs and ≥2 wearable monitors. Outcomes, defined as Arrhythmia control (0-6 self-terminating recurrences, with ≤1 cardioversion for nonparoxysmal AF) and Freedom from arrhythmias (no recurrences on or off antiarrhythmic drugs), were compared at 1 year between patients undergoing catheter ablation who enrolled and declined RFM. Results: Between 1 November 2016 and 1 April 2018, 195 patients enrolled and 196 declined RFM (body mass index, 35.1 ± 6.7 vs 34.3 ± 6.3 kg/m 2 ; 50% vs 50% paroxysmal AF; P = NS). At 1 year, enrolled patients demonstrated significant weight loss (4.7% ± 5.3% vs 0.3% ± 4.4% in declined patients; P < .0001) and improved OSA care (78% [n = 43] of patients diagnosed with OSA began treatment). However, outcomes were similar between enrolled and declined patients undergoing ablation (arrhythmia control in 80% [n = 48] vs 79% [n = 38]; freedom from arrhythmia in 58% [n = 35] vs 71% [n = 34]; P = NS). Conclusion: Despite improving weight loss and OSA care, our nurse-led RFM program did not impact 1-year arrhythmia outcomes in patients with AF undergoing catheter ablation. K E Y W O R D S atrial fibrillation, catheter ablation, obesity, obstructive sleep apnea, risk factors, weight loss

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Impact of weight loss on ablation outcome in obese patients with longstanding persistent atrial fibrillation

Abstract: In this prospective analysis, in LSPAF patients weight loss improved QoL but had no impact on symptom severity and long-term ablation outcome.

Cited by 54 publications

References 25 publications

Weight loss in obese patients with longstanding persistent atrial fibrillation undergoing catheter ablation: Is it worth the trouble?

Weight loss in obese patients with longstanding persistent atrial fibrillation undergoing catheter ablation: Is it worth the trouble?

Lifestyle modifications for treatment of atrial fibrillation

Impact of a nurse‐led limited risk factor modification program on arrhythmia outcomes in patients with atrial fibrillation undergoing catheter ablation

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