Aggressive Management of Obesity and Other Atrial Fibrillation Risk Factors

A new study presented at the recent meeting of the Heart Rhythm Society indicates that treating risk factors associated with atrial fibrillation (AF) can dramatically reduce the burden of the disease or eliminate it entirely.

Researchers in Australia found that an intense post-surgical program of medical treatment and behavior modification more than doubled the disease-free survival rate for initial ablations and boosted the chance of disease-free survival after multiple ablations from 48% to 87%.

That study began when researchers looked for atrial fibrillation patients who had just undergone their first ablation and selected 165 who also had a body mass index > 27 and a risk factor such as diabetes, hypertension, sleep apnea or abnormal lipids.

All patients were then offered the opportunity to participate in a comprehensive risk-factor-management program. The 61 patients who accepted the offer became the trial group, while the 88 who declined became the control group.

The trial group received medical treatment for hyperlipidemia, glucose intolerance, high blood pressure, and sleep apnea. Doctors also provided intense counseling designed to get patients eating better, exercising more, drinking less and shunning tobacco.

Patients in the trial group improved their glycemic control and experienced significant reductions in body weight, blood pressure and nocturnal hypoxic episodes. They also saw significant changes to the structure of their hearts. Left atrial volume declined, as did diastolic left ventricle volume.

Researchers followed both groups for two years after the initial ablation and found that atrial fibrillation recurred at least once in 74% of the control arm but just 38% of the trial group. After accounting for subsequent ablations, atrial fibrillation-free survival at two years was 87% in the risk-factor-modification group but only 48% in the control group.

The “ARREST-AF” trial is the third related finding from the team at the University of Adelaide’s Centre for Heart Rhythm Disorders and the Royal Adelaide Hospital.

At last year’s Heart Rhythm Society meeting, they presented evidence that weight loss improved structural and electrical properties in the atria of obese sheep. Then, last fall, they published a paper in the Journal of the American Medical Association concluding that weight management was associated with greatly reduced disease burden among obese atrial fibrillation patients.

That 18-month study randomized 150 patients into a control group that got general lifestyle advice and a weight-management group that followed a specific program of diet and exercise.

Not surprisingly, the weight-management group lost more weight (14.3 and 3.6 kg, respectively; P&thinsp;<&thinsp;.001). It also experienced a far greater reduction in atrial fibrillation symptom burden scores (11.8 and 2.6 points, P&thinsp;<&thinsp;.001), symptom severity scores (8.4 and 1.7 points, P&thinsp;<&thinsp;.001), number of episodes (2.5 and no change, P&thinsp;=&thinsp;.01), and cumulative duration (692-minute decline and 419-minute increase, P&thinsp;=&thinsp;.002).

Patients in the weight-management group also saw their cholesterol levels improve while blood sugar and blood pressure dropped. Many of them were able to reduce medication levels or discontinue medication altogether.

Together, the researchers concluded, these studies suggest that aggressive management of obesity and other atrial fibrillation risk factors could greatly reduce the incidence of the disease and its severity in remaining cases.