Feasibility of weight loss in obese atrial fibrillation patients attending a specialist arrhythmia clinic and its impact on ablation outcomes

Abstract

Background The feasibility of significant weight reduction in a specialist arrhythmia service, and its impact on atrial fibrillation (AF) ablation outcomes are unclear. We aimed to assess these factors in a real‐world cohort in the United Kingdom. Methods Patients from one specialized arrhythmia clinic were instructed to follow the “Intermittent Fasting 5:2 diet” (“diet group”, n = 50), and their outcomes were compared to a propensity matched cohort who received no specific dietary advice (“control group”, n = 42). The primary outcome was recurrence of AF or atrial tachycardia (AT) at 12 months postablation, with or without drugs. Results Body weight and body mass index (BMI) at baseline were 105.0 (±15.3) kgs and 36.0 (±4.0), respectively. Baseline characteristics between the two groups were comparable. Patients in diet group experienced a mean weight loss of 8.2 (±7.1) kgs prior to AF ablation (P < .01 for comparison to baseline and control group). About 14 (28%) patients in the diet group lost >10% of their body weight. Overall, 11 (22%) patients in the diet group and five (12%) in the control group had AF recurrence at 1 year, P = .21. AF recurrence was similar in patients with BMI ≥ 35 (15%) as compared to BMI < 35 (19%), P = .60. There was one procedural complication (pulmonary edema) in the diet group. Conclusion It is feasible to achieve significant weight reduction in obese AF patients in a specialist arrhythmia clinic setting with unsupervised dietary advice. Low rates of procedural complications and excellent medium‐term success rates were observed in this traditionally challenging population. Additional improvements in outcomes were not demonstrable in patients who exhibited significant weight loss.

Utilization and in‐hospital complications of catheter ablation for atrial fibrillation in patients with obesity and morbid obesity

“…On the contrary, several studies have pointed out the obesity paradox effect owing to the favorable cardiovascular outcomes observed on anticoagulated AF patients with obesity compared to nonobese 4 . Furthermore, one study suggested weight loss in obese patients who underwent AF ablation, surprisingly, did not improve AF recurrence rates 5 …”

“… 4 Furthermore, one study suggested weight loss in obese patients who underwent AF ablation, surprisingly, did not improve AF recurrence rates. 5 …”

“…4 Furthermore, one study suggested weight loss in obese patients who underwent AF ablation, surprisingly, did not improve AF recurrence rates. 5 Catheter ablation has been widely accepted as a principal treatment for AF 6 and has become the first line in particular subgroups such as younger and athletic patients. 7 The majority of ablation outcomes in large clinical trials have come from exclusively high-volume academic centers with experienced operators.…”

Association between weight loss and outcomes in patients undergoing atrial fibrillation ablation: a systematic review and dose–response meta-analysis

“…Table 1 and Additional file 1: Table S4 summarizes the characteristics of the included studies. One randomized open-labeled,clinical trial [21] with 133 (weight loss = 67, control = 66) patients and seven cohorts with 1150 patients (prospective [22][23][24][25][26][27] = 6, retrospective [19] = 1) were included. Overall, these studies were published between 2014 and 2021.…”

Considerations for the Assessment of Substrates, Genetics and Risk Factors in Patients with Atrial Fibrillation

“…65 Despite these described positive responses to risk factor management programmes in AF, other studies could not confirm these beneficial effects, suggesting, that there are potentially non-weight responsive forms of AF in some patients. [70][71][72][73] Previous work showed that idiopathic AF patients develop cardiovascular disease more often, at a younger age and with a more severe disease profile compared to healthy sinus rhythm controls, suggesting the presence of subclinical comorbidities. 74 Similarly, in a recent retrospective study young AF patients (mean age 46 years), only 11% of patients were free of AF risk factors or comorbidities, whereas 44% had hypertension and 25% had a family history of AF.…”