Abstract 19651: The Current Model for Recognition and Modification of Risk Factors for Atrial Fibrillation is Ineffective
Introduction: There is growing data that successful modification of risk factors (RF) for atrial fibrillation (AF) can significantly improve the outcomes of AF therapies. These RFs include obesity, exercise, hypertension, diabetes, cholesterol, smoking, and obstructive sleep apnea (OSA). RF modification has mostly been delegated out of electrophysiology clinics to primary care providers.
Hypothesis: The current model for recognition and modification of RF for AF is suboptimal.
Methods: Consecutive patients referred to the University of Virginia for initial ablation of paroxysmal or persistent AF with a minimum of 90 days of follow-up since September 2010 were included in this study. RFs were compared immediately pre- and at latest follow-up post ablation. RFs included body mass index (BMI), hypertension, treated obstructive sleep apnea, Type 1 or 2 diabetes, lipid profile and smoking.
Results: Of 1750 ablation patients, 1190 met inclusion criteria. Mean age at ablation was 64 years, 63% male, mean LA dimension 4.1cm, mean LVEF 50%, with a mean follow up was 553 days. Half of patients were obese pre-ablation with a mean BMI of 35 kg/m2. There was no significant improvement in any of the RF except for smoking. In fact, there was a significant increase in hypertension, diabetes, OSA and a trend to increased cholesterol and left atrial diameter. OSA was diagnosed in only 5% of patients pre ablation despite 50% obesity. Lipid profiles were documented in only 34% pre ablation.
Conclusion: Our current model for recognition and modification of RF for AF is ineffective in achieving weight loss, controlling BP, preventing diabetes, screening for OSA and hypercholesterolemia. Reducing AF burden does not appear to alter this risk factor profile. Alternative practice models are needed to significantly modify AF risk factors.
Author Disclosures: A. Mealor: None. J. Ferguson: Honoraria; Modest; Biosense Webster, Inc, st. Jude Medical. Consultant/Advisory Board; Modest; Biosense Webster, Inc, St. Jude Medical. K. Bilchick: Consultant/Advisory Board; Modest; Biosense Webster. W. Camnitz: None. A. Darby: Consultant/Advisory Board; Modest; Biosense Webster, Inc. M. Mangrum: Research Grant; Modest; Hansen Medical, Boston Scientific Corp, St. Jude Medical, Cardiofocus. Consultant/Advisory Board; Modest; St. Jude Medical, Hansen Medical, Phillips. R. Malhotra: Research Grant; Modest; Boeringer Ingleheim. Speakers Bureau; Modest; Medtronic, Inc. P. Mason: Honoraria; Modest; Medtronic, Inc. Consultant/Advisory Board; Modest; Medtronic, Inc. M. Murphu: None.
- © 2016 by American Heart Association, Inc.