Losing weight before catheter ablation in initially overweight or obese atrial fibrillation (AF) patients may increase the likelihood of arrhythmia resolution, at least in the short term, new analysis suggests was done.
This finding comes from a small study of patients with paroxysmal, especially persistent AF, who are candidates for ablation. People who lost at least 3% of their body weight in the months before surgery while participating in a structured risk factor modification (RFM) program were “dramatically” more likely to be free of AF after 6 months. rice field.
The improvement in ablation efficacy was most pronounced among patients with persistent AF, compared with results from similar patients who lost less weight, researchers said at a meeting on May 19. reported at the Heart Rhythm Society (HRS) 2023 Scientific Session. at New Orleans.
Of note, ablation in this study was consistently limited to standard pulmonary vein isolation (PVI) whenever possible.
Association of AF with obesity and other behavior- and lifestyle-related risk factors well recognizedHowever, the limited studies on their effect on AF ablation success are inconsistent. According to the researchers, the current analysis specifically points to weight loss before ablation as a means of improving AF ablation outcomes.
Jeffrey J. Goldberger, M.B.A., Miami Health System University, Miami, Florida, says, “Treatment regimens for obese patients undergoing ablation for atrial fibrillation should incorporate adjuvant therapy with an emphasis on weight loss. is,” he said when announcing the new results. at the HRS session.
Such a plan is fully consistent with recent guidelines, especially the 2020 American Heart Association (AHA). consensus statementHowever, it is inconsistent and probably rarely realized in clinical practice.
Dramatically increased success rate
Even modest weight loss before ablation might help, suggested Goldberger, director of the hospital’s Atrial Fibrillation Center. In fact, on average, the significant weight loss group lost less than 6% of his baseline weight.
Still, it was clearly sufficient to significantly improve ablation results. Eighty-eight percent had resolution of atrial fibrillation 6 months after surgery, compared with only 61% of patients who lost less than 3% of their weight before ablation.
“We’re talking moderate weight loss. These patients aren’t going from obese to lean. They’re still pretty overweight,” he said. said.
An analysis limited to four-fifths of patients with persistent atrial fibrillation “saw the same pattern,” Goldberger said in a media presentation ahead of the formal presentation at the HRS session.
Moreover, the effect in that subgroup lasted up to 12 months, at which time 42% and 81% of patients with low and high weight loss, respectively, were free of atrial fibrillation. This “means that the success rate of pulmonary vein isolation in people who lose weight has increased quite astonishingly, indeed dramatically,” he said.
“We’ve long known that weight loss is important in preventing atrial fibrillation and increasing the success of various treatments,” said Cynthia M. Tracy, M.D. heart.org | Medscape Cardiology. “Perhaps in some studies, weight loss was as effective as antiarrhythmic drugs.”
A 3% weight loss is “no big deal,” she says. In her current analysis, she said, “It’s remarkable that even a fairly modest weight loss can make such a big difference.”
“When asked, ‘How much weight do you need to lose before considering ablation?’ ,” said Tracy of George Washington University Hospital. , Washington, DC, not relevant to this study.
Evolving view of AF
The findings are emblematic of the professional’s evolving view of AF and its management, Goldberger said at a press conference. Should clinicians think of atrial fibrillation in the same way as a “Wolf-Parkinson-White syndrome”? Patients are usually successfully ablatedand “do you expect it to last forever without further intervention?”
Or is atrial fibrillation more like coronary artery disease, where even with therapeutic intervention the disease is still progressing and requires long-term disease management? I think it’s pretty clear. in the latter case. “
Goldberger’s report was an interim analysis of an ongoing randomized trial. leaf In (effect of liraglutide on atrial fibrillation), AF patients were assigned to “take” and “do not take” the GLP-1 receptor agonist liraglutide, an antidiabetic drug (Victoza) and a weight loss drug (Saxenda). are compared. The trial was designed to assess the drug’s apparent ability to shrink atrial epicardial adipose tissue, and Goldberger said the drug contributed to the development of atrial fibrillation and the outcome of atrial fibrillation ablation. said to be likely to affect
He said it was unclear whether the observed association between pre-ablation improvement and successful weight ablation was “particularly related to weight loss, liraglutide treatment, or both,” a limitation of the current analysis. said it was.
Dr. David Frankel, who attended Goldberger’s presentation as an invited discussant, noted inconsistent studies on whether significant weight loss improves outcomes from atrial fibrillation rhythm-control therapy.
People who found such connections, including LEAF and influential people heritage This study differs from other studies that have shown no effect by incorporating a “comprehensive risk factor management” program, observed Dr. Frankel of the University of Pennsylvania Hospital and Penn Cardiovascular Center in Philadelphia.
Frankel said studies linking weight loss to AF rhythm control should not focus solely on weight loss or sleep apnea as risk factors for AF, but rather include “hypertension, diabetes, hyperlipidemia, and smoking cessation.” , and alcohol reduction.” “It is therefore clear that we need to focus on all these factors of metabolic syndrome to have a significant impact on recurrence of atrial fibrillation.”
Comprehensive risk factor management
LEAF included AF patients who were also randomly assigned to receive liraglutide or placebo according to the RFM program. The “nurse-led” RFM program, delivered both in clinic and online, includes AHA diet and lifestyle recommendations, exercise prescriptions, dietary counseling, sleep apnea assessment and treatment, and strategies. It was characterized by ‘targets set for each patient’ using Goldberger said it’s important to control diabetes, hyperlipidemia and high blood pressure. Patients were then “counseled on alcohol reduction and smoking cessation as needed.”
After 3 months, 29 and 30 patients lost less than 3% and at least 3% of baseline weight, respectively, regardless of randomization assignment.
Patients in both weight-reduction groups (79% with persistent atrial fibrillation and the rest with paroxysmal atrial fibrillation) had an average weight of 106.4 kg (234 lb) before starting the RFM program. After three months, their average weights were 106.4 kg (234 lb) and 103.6 kg (228 lb) respectively.P. < .001).
PVI was achieved in all patients by catheter ablation. A 3-month blank period followed, after which they discontinued antiarrhythmic drugs.
table. Effect of weight loss on the rate of atrial fibrillation relief after intention-to-treat ablation
| Elapsed time since ablation | <3% loss (%) | ≥ 3% loss (%) | P, Fisher test | P, ordinal regression |
|---|---|---|---|---|
| all patients | ||||
| 6 months | 61 | 88 | .046 | .031 |
| Permanent AF Subgroup | ||||
| 6 months | 61 | 90 | .058 | .051 |
| 12 months | 42 | 81 | <.05 | .038 |
Losing more than 10% of body weight is very difficult for patients and “it doesn’t happen overnight,” Tracy said. “These patients are most often symptomatic when referred to an electrophysiologist, so an indefinite delay is not desirable.”
He said the results of the current study point to a “more realistic goal,” suggesting that weight loss of at least 3% should increase the likelihood of successful AF ablation.
Goldberger said he received honorariums and commissions from Medtronic for speaking and consulting. Mr. Frankel said he received honoraria and commissions for speaking and consulting from Medtronic, Stryker, Biosense-Webster and Boston Scientific. Tracy has not reported any related financial relationships.
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