Abstract 14759: Aggressive Risk factor REduction STudy: Implications for the Substrate for Atrial Fibrillation (ARREST-AF Substrate Study)
Introduction: Cardiac risk factors (RF) such as hypertension, diabetes mellitus, obesity and sleep apnoea have been associated with structural and electrical remodeling of the atria that forms the substrate leading to the development and progression of atrial fibrillation (AF). We evaluated the impact of aggressive management of RFs on the AF substrate.
Methods: 50 consecutive AF pts with BMI ≥ 27 kg/m2 and ≥1 cardiac risk factor were randomized to either RF management (RFM) or usual care (Control). The RFM group were managed in a physician-led clinic directed at RF control in accordance with AHA/ACC guidelines. Both the groups were studied with electrophysiological (EP) study, echocardiography, cardiac MRI, serum fibrosis and endothelial function markers at baseline and repeated at > 6 mths later. Subjects in RFM group had >10% weight loss at repeat study.
Results: There were no differences in baseline characteristics or follow-up duration (15±3 mths) between the groups (p=NS). RFM resulted in greater reduction in weight (p<0.001), systolic blood pressure (p=0.004), better glycaemic control (p=0.003) and lipid profile (p=0.04), reduced LA size (p=0.003) and total pericardial fat volume (p=0.001). The table presents the data showing that RFM resulted in marked reversal in atrial electrical parameters, reduced pro-inflammatory/fibrotic markers and improved endothelial/platelet function.
Conclusion: Aggressive risk factor management reverses electrical and structural remodeling and results in a significant improvement in endothelial and platelet function underscoring its importance in AF management. (Trial registration: ACTRN12613000444785)
Author Disclosures: R.K. Pathak: None. M.E. Middeldorp: None. S. Stolcman: None. S. Willoughby: None. R. Mahajan: None. D.H. Lau: None. P. Sanders: None.
- © 2015 by American Heart Association, Inc.