A new clinical trial has found that overweight and obese patients with persistent and paroxysmal atrial fibrillation (AF) who lose weight before a catheter ablation procedure have improved clinical outcomes. This study, led by researchers from UHealth—the University of Miami Health System and the Miller School of Medicine, identifies weight loss before undergoing an ablation procedure as a risk-factor reduction tool for AF patients. The findings were presented at the recent Heart Rhythm 2023 conference.
AF is the most common type of arrhythmia, affecting approximately 2.3 million people in the United States, with 160,000 new cases diagnosed every year. Catheter ablation is a frequently used treatment for people with arrhythmias that can’t be controlled by medication or with certain types of arrhythmias from the heart’s upper chambers.
While catheter ablation is a common AF treatment option, researchers are continuously evaluating how to improve AF ablation patient outcomes. This trial sought to determine if additional non-ablation therapy targets can be integrated into treatment plans for patients undergoing catheter ablation for persistent AF and paroxysmal AF.
The study enrolled and randomized 65 patients with a BMI≥27 kg/m2 who opted for catheter ablation to treat AF to a 3-month pre-ablation period of standard risk factor modification (RFM) or RFM plus Liraglutide. Among the enrolled participants were 59 patients (age 62±9 years, 27% female) weighing 106.4±18.5 kg (BMI 36.1±5.8 kg/m2); 79% had persistent AF and 21% had paroxysmal AF with 85% having hypertension, 27% diabetes, and 44% obstructive sleep apnea.
The results showed AF status from enrollment to 6 months post-ablation. 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. Freedom from AF off antiarrhythmic drugs at 6 months was 61% in Group 1 versus 88% in Group 2 (Fisher’s Test p=0.046, OLR p=0.0431).
For patients with persistent AF treated with ablation (including one whose AF resolved with weight loss), freedom from AF off antiarrhythmic drugs at 6 months was 61% in Group 1 versus 90% in Group 2 (Fisher’s Test p=0.058, OLR p=0.051) and at 12 months was 42% in Group 1 versus 81% in Group 2 (Fisher’s Test p=0.050, OLR p=0.038).
Jeffrey Goldberger, M.D., M.B.A, Director, Center for Atrial Fibrillation, Professor of Medicine & Biomedical Engineering at UHealth—the University of Miami health System and the Miami Miller School of Medicine, said, “We are constantly evolving our approach to AF to identify new ways to prevent recurrence and improve long-term outcomes. 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.”
He added, “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.”
The authors of this trial would like to see additional trials focused on assessing the role of weight and weight loss in improving AF ablation outcomes and potentially identifying novel procedural approaches.
This study highlights the importance of considering weight loss as a risk-factor reduction tool for AF patients, especially prior to undergoing a catheter ablation procedure. It serves as a reminder for physicians to integrate weight loss and risk factor modification into treatment plans to improve clinical outcomes for overweight and obese AF patients. Further research in this area is necessary to better understand the role of weight loss in AF ablation outcomes.
