Weight Loss Prior to Atrial Fibrillation Ablation May Improve Patient Outcomes

Jeffrey Goldberger, MD, MBA

Credit: University of Miami

Patients with overweight and obesity with persistent and paroxysmal atrial fibrillation who lost weight prior to catheter ablation experienced improved clinical outcomes, according to new clinical trial findings.¹

The research, presented in a late-breaking clinical trial session at Heart Rhythm 2023, suggested patients with high body mass index (BMI) who lost ≥3% of their body weight prior to ablation saw greater freedom from atrial fibrillation post-ablation procedure.

“We are constantly evolving our approach to atrial fibrillation to identify new ways to prevent recurrence and improve long-term outcomes,” Jeffrey Goldberger, MD, MBA, director of the Center for Atrial Fibrillation and professor of biomedical engineering at the University of Miami Miller School of Medicine, said in a statement.¹ “While we already know the impact weight can have on overall outcomes, we believe the magnitude of the effect during this study is quite striking and that the findings show that even moderate weight loss may lead to a positive effect, but further analysis incorporating the potential independent contribution of liraglutide is necessary.”

The most common type of arrhythmia, approximately 2.3 million people across the United States have atrial fibrillation with 160,000 new cases diagnosed every year.² For people with arrhythmias that can’t be controlled by medication or with certain types of arrhythmias from the heart’s upper chambers, catheter ablation is a frequently used treatment. However, despite catheter ablation being a common treatment option, researchers are constantly looking for ways to improve patient outcomes in atrial fibrillation ablation.

The current study looked to determine if additional non-ablation therapy targets can be integrated into treatment plans for patients undergoing catheter ablation for persistent atrial fibrillation and paroxysmal atrial fibrillation. A total of 65 patients with body mass index (BMI) ≥27 kg/m2 who chose catheter ablation to treat atrial fibrillation were enrolled in the study and randomized to a 3-month pre-ablation period of standard risk factor modification (RFM) or RFM plus liraglutide.

Of those enrolled in the study, there were 59 patients (mean age, 62 years; 27% female) weighing 106.4±18.5 kg (BMI 36.1±5.8 kg/m2), while 79% had persistent atrial fibrillation and 21% had paroxysmal atrial fibrillation. Moreover, 85% had hypertension, 27% had diabetes, and 44% had obstructive sleep apnea.

Individuals with a <3% weight change prior to the ablation procedure were denoted as Group 1 and patients with a ≥3 - 10% weight change were classified as Group 2. Study results reported atrial fibrillation status from study enrollment to 6 months post-ablation. The analysis showed Group 1 had 29 patients with 0.2±2.7% weight gain and Group 2 had 30 patients with 5.6±1.8% weight loss.

Investigators found freedom from atrial fibrillation off antiarrhythmic drugs at 6 months was 61% of individuals in Group 1, compared with 88% of individuals in Group 2 (Fisher’s Test P = .046; OLR P = .0431). Moreover, for patients with persistent atrial fibrillation treated with ablation (including one whose atrial fibrillation resolved with weight loss), freedom from atrial fibrillation off antiarrhythmic drugs at 6 months was 61% in Group 1 versus 90% in Group 2 (Fisher’s Test P = .058; OLR P = .051). At 12 months, the data showed 42% of Group 1`and 81% of Group 2 (Fisher’s Test P = .050; OLR P = .038) experienced freedom from atrial fibrillation off antiarrhythmic drugs.

Goldberger indicated the investigative team's desire to see additional trials focused on assessing the role of weight and weight loss in improving atrial fibrillation ablation outcomes, as well as the potential to identify novel procedural approaches.

“We hope that our findings will encourage physicians to integrate weight loss and risk factor modification into their treatment plans for patients undergoing catheter ablation and drive even more research dedicated to finding additional supportive solutions for patients living with AF,” Goldberger said in the statement.²

References

1. University of Miami Health System MS of M. Weight loss before AFIB ablation procedure results in improved outcomes among obese patients. Newswise. May 19, 2023. Accessed May 25, 2023. https://www.newswise.com/articles/weight-loss-before-afib-ablation-procedure-results-in-improved-outcomes-among-obese-patients?ta=home.
2. Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circ Res. 2020;127(1):4-20. doi:10.1161/CIRCRESAHA.120.316340