Aggressive Risk factor REduction STudy: implications for the substrate for Atrial Fibrillation (ARREST-AF Substrate Study)

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication

“…196 In humans, aggressive management of weight and associated risk factors is associated with favourable changes in pericardial fat volume, atrial size, myocardial mass as well as electrophysiological and electroanatomical changes along with reduced AF inducibility and burden. 197 Furthermore, weight loss in morbidly obese subjects is associated with reduced epicardial fat. 198 Weight reduction in obese individuals can result in regression of LV hypertrophy, reduction in left atrial size and reduction in AF burden/severity.…”

EHRA/HRS/APHRS/SOLAECE expert consensus on Atrial cardiomyopathies: Definition, characterisation, and clinical implication

“…In the ovine model of chronic obesity, weight reduction is associated with reduction in total body fat, atrial dilatation, and interstitial fibrosis together with improved hemodynamics, atrial connexin-43 expression and conduction properties that result in reduced vulnerability to AF [196] . In humans, aggressive management of weight and associated risk factors is associated with favourable changes in pericardial fat volume, atrial size, myocardial mass as well as electrophysiological and electroanatomical changes along with reduced AF inducibility and burden [197] . Furthermore, weight loss in morbidly obese subjects is associated with reduced epicardial fat [198] .…”

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

“…In that context, it is interesting to note that despite the relatively higher BMI, the prevalence of sleep apnea was only ∼ 25% in these subjects. This appears significantly lower than the sleep apnea prevalence rates of ∼ 50% that have been previously reported in studies on obese AF patients with relatively lower BMI . This raises the possibility that sleep apnea may have been underdiagnosed in this series.…”

“…Epicardial fat has been shown to promote localized inflammation and fibrosis that, in turn, may lead to adverse atrial electrophysiologic remodeling and AF . Successful weight loss in obese subjects can reverse such adverse remodeling . This suggests that weight loss may be able to affect favorably the underlying AF substrate.…”

“…This study also raises valid concerns about the ideal model for comprehensively addressing risk factors and particularly obesity in AF patients long term. As these investigators point out, the physician‐led weight loss program that was used in the Australian experience, while quite successful, may not be universally replicable. Perhaps a more cost‐effective approach may be to utilize other health care providers such as nurses and/or physician extenders who can be specifically trained to identify and address common risk factors in AF patients.…”