Lifestyle modifications for treatment of atrial fibrillation

Abstract

<jats:p>The management of atrial fibrillation (AF) has focused on anticoagulation, rhythm control and ventricular rate control. Recently, a fourth pillar of AF management has been incorporated recognising the importance of risk factor management (RFM). There are several risk factors that contribute to the development and progression of AF, these include traditional risk factors such as age, hypertension, heart failure, diabetes and valvular heart disease. However, increasingly it is recognised that obesity, sleep apnoea, hyperlipidaemia, smoking, alcohol, physical inactivity, genetics, aortic stiffness are associated with the development of AF. Importantly, several of these risk factors are modifiable. We have seen the evolution of RFM programmes which have demonstrated promising results. Indeed, the evidence is now so compelling that major clinical guidelines strongly advocate that aggressive treatment of these risk factors as a key component of AF management. Patients with AF who comprehensively managed their risk factors demonstrate greater reduction in symptoms, AF burden, more successful ablations and improved outcomes with greater AF freedom. In this article, we will review the evidence for the association between cardiac risk factors and AF and assess the burgeoning evidence for improved AF outcomes associated with aggressive cardiac RFM.</jats:p>

Effect of targeted education for atrial fibrillation patients: Design of the EduCare‐AF Study

“…11 A recent review emphasized the importance of lifestyle and cardiovascular risk factor management (hypertension, obstructive sleep apnoea, diabetes,…) which has shown to reduce AF burden and symptoms but also to improve success rates of rhythm restoring procedures and the quality of life in AF patients. 12 This is also incorporated in the integrated AF care model. The premises described above formed the fundamentals of the EduCare-AF study, of which we will describe the protocol below.…”

Implementation of an on-demand app-based heart rate and rhythm monitoring infrastructure for the management of atrial fibrillation through teleconsultation: TeleCheck-AF

“…In recent online statements on the European Society of Cardiology website as well as in consensus papers on the guidance for the management of AF patients during the COVID-19 pandemic from the Heart Rhythm Society, American College of Cardiology, and American Heart Association, 15 the use of telemedicine and mHealth solutions for remote patient care are recommended. However, a universal solution to allow wide and fast implementation of mHealth infrastructures is not provided.…”

“…During COVID-19, the accessibility to elective interventions and procedures such as electrical cardioversion as well as elective invasive interventions such as AF ablation is limited. 16 Nevertheless, remote adaptation of rate and rhythm medication guided by the on-demand monitoring infrastructure together with a comprehensive risk factor management, which has been shown to maintain sinus rhythm and reduce the need of AF ablation, 15 are elemental parts of TeleCheck-AF and helps managing AF patients during the COVID-19 pandemic.…”

Lifestyle interventions after ablation for atrial fibrillation: a systematic review

“…The findings of this review confirm the European and the AHA guidelines and the newest literature on the subject that say that lifestyle and risk factor management interventions are pillars of the most optimal AF patient care, with ablation treatment or without. 1,6,9 The important contribution that the management of comorbidities and risk factors makes in improved AF patient outcomes has been recognised by recent international AF guidelines. 1,53 Guideline driven, evidencebased care of the AF patient has become more complex involving rate and rhythm control, therapies to maintain sinus rhythm (such as cardioversion and ablation), stroke prevention, and risk factor modification.…”