Abstract 15126: Weight and Risk Factor Modification: Impact on Atrial Fibrillation
Background Obesity is recognized as a risk factor for atrial fibrillation (AF). Whether weight and risk factor management can reduce the burden of AF is unknown.
Methods One hundred and fifty overweight and obese patients defined by body mass index (BMI) and waist circumference (WC) with symptomatic AF were randomized to either a structured intensive risk factor and weight management program (intervention) or general lifestyle advice (control) and followed for 15 months. Cardiometabolic risk factors, alcohol use and sleep apnea were identified and managed. The primary outcome measure was AF severity assessed by the AF Severity Score (AFSS; frequency, duration, severity and symptom severity subscale) and 7-day Holter recording. Secondary outcomes were cardiac structural changes and cardio-metabolic plasma markers.
Results Structured intervention resulted in significantly greater weight reduction compared to control. By 15 months, weight had decreased from 98.8±13.1 to 80.2±12.5 kg (P<0.001) in the intervention group and from 101.4±16.4 to 95.9±18.3 kg (P=0.001) in the control group, with divergence between groups observed at 3 months and beyond (P<0.001 at 3-15 months). At 15 months, the control group showed a significant reduction in AF severity scores (P=0.01) but not AF symptom subscale (P=0.1) group, whereas both decreased significantly in the intervention group (P<0.001). Compared to controls, the intervention group demonstrated a greater reduction in the AF severity score (P<0.001) and the symptom subscale (P<0.001). On continuous 7-day ambulatory cardiac rhythm recording, AF episodes decreased by 80% in the intervention group while there was no significant change in the control group, (P=0.002). Additionally, there was a 53% reduction in AF duration in the intervention group compared to a 30% increase in controls, (P=0.01). Associated with weight loss was a greater reduction in hsCRP (P=0.001), left atrial volume (P<0.001), left ventricular hypertrophy and mass (P=0.01) in the intervention group compared to the controls.
Conclusion Intensive weight and cardiometabolic risk factor management is associated with reversal of atrial dilation, ventricular hypertrophy and a marked reduction of AF. Trial registration: ACTRN12610000497000.
- © 2012 by American Heart Association, Inc.