Obesity is well known to promote atrial fibrillation (AF), and catheter ablation can dramatically cut back on AF prevalence. The SORT-AF (Supervised Obesity Reduction Trial in Atrial Fibrillation) randomized study follows numerous, mostly observational studies suggesting that weight loss, exercise, and risk-factor modification protocols can alleviate AF symptoms and prevalence.
The trial"s 133 patients, of whom 57% had persistent AF and the remainder paroxysmal AF, averaged 60 years of age, and 38% were women. After the comprehensive preablation evaluation, ILR implantation, and AF ablation by pulmonary vein isolation, 67 were assigned to the postablation structured weight-reduction program and 66 to usual care. The study intervention included medical advice regarding nutrition and physical training on a regular basis along with cognitive behavior therapy. The study"s intervention group lost an average 4.5% in body weight, the control group less than 1.0%.
The primary endpoint, AF burden at 12 months excluding a 3-month blanking period, was similar in the two groups. The drop in BMI for patients assigned to the intervention correlated with fewer AF recurrences among patients initially with persistent than with paroxysmal AF (P = .032). The hazard ratio for AF recurrence in those with both persistent AF and improved exercise capacity was 0.77 (95% CI, 0.64 - 0.93).
The conclusion is that although the primary endpoint of AF-burden after ablation did not differ between the two groups, the effects of weight loss and improvement of exercise activity were beneficial for obese patients with persistent AF demonstrating the relevance of life-style management as an important adjunct to AF-ablation in this setting.
Medscape Medical News, May 6, 2021
https://academic.oup.com/europace/advance-article/doi/10.1093/europace/euab122/6247032
