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Aggressive Risk Factor Reduction Study for Atrial Fibrillation and Implications for the Outcome of Ablation
Open accessAbstract
Background The long-term outcome of atrial fibrillation (AF) ablation demonstrates attrition. This outcome may be due to failure to attenuate the progressive substrate promoted by cardiovascular risk factors.Objectives The goal of this study was to evaluate the impact of risk factor and weight management on AF ablation outcomes.Methods Of 281 consecutive patients undergoing AF ablation, 149 with a body mass index ≥27 kg/m(2) and ≥1 cardiac risk factor were offered risk factor management (RFM) according to American Heart Association/American College of Cardiology guidelines. After AF ablation, all 61 patients who opted for RFM and 88 control subjects were assessed every 3 to 6 months by clinic review and 7-day Holter monitoring. Changes in the Atrial Fibrillation Severity Scale scores were determined.Results There were no differences in baseline characteristics, number of procedures, or follow-up duration between the groups (p = NS). RFM resulted in greater reductions in weight (p = 0.002) and blood pressure (p = 0.006), and better glycemic control (p = 0.001) and lipid profiles (p = 0.01). At follow-up, AF frequency, duration, symptoms, and symptom severity decreased more in the RFM group compared with the control group (all p < 0.001). Single-procedure drug-unassisted arrhythmia-free survival was greater in RFM patients compared with control subjects (p < 0.001). Multiple-procedure arrhythmia-free survival was markedly better in RFM patients compared with control subjects (p < 0.001), with 16% and 42.4%, respectively, using antiarrhythmic drugs (p = 0.004). On multivariate analysis, type of AF (p < 0.001) and RFM (hazard ratio 4.8 [95% confidence interval: 2.04 to 11.4]; p < 0.001) were independent predictors of arrhythmia-free survival.Conclusions Aggressive RFM improved the long-term success of AF ablation. This study underscores the importance of therapy directed at the primary promoters of the AF substrate to facilitate rhythm control strategies.
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“Moderate or severe OSA (AHI ≥ 15) is reported in 20%–62%.330,704,706,710–715”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [330]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“In studies, such as the ARREST-AF cohort study or the ACTIVE-AF trial, regular exercise programs exhibited a reduction in AF-related symptoms, AF incidence, and AF recurrence rates [76,77].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [76]
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“Other groups have studied the relationship between subjective (grade) or objective (volume/weight) tonsil evaluation and AHI and reported a trend toward significance328 or a significant association.318,329–334”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [330]
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“Given the high incidence of AF after CTI ablation for typical AFL”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [166]
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“Intensive weight-reduction management in addition to management of other cardiovascular risk factors (in the range of 10-15 kg weight loss achieved) led to fewer AF recurrences and symptoms compared with an approach based on general advice in obese patients with AF.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [203]
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Gallagher, C., Stokes, M. B., Sanders, P., & Lau, D. H. (2019) · Heart Rhythm · doi:10.1016/j.hrthm.2019.10.023 · Cited by 2
Self-citationNovel Personalised Determinants of Atrial Substrate in Atrial Fibrillation
Wong, G. R. (2019) · Minerva Access (University of Melbourne) · Cited by 1
Catheter ablation of atrial fibrillation in overweight and obese patients: Where do we stand?
Letsas, Κ. P. (2020) · International Journal of Cardiology · doi:10.1016/j.ijcard.2020.07.019 · Cited by 1
Freedom from atrial fibrillation after catheter ablation: Survival of the fittest
Black‐Maier, E., & Piccini, J. P. (2020) · Heart Rhythm · doi:10.1016/j.hrthm.2020.05.037 · Cited by 1
Risk Factor Modification for Atrial Fibrillation
Estes, N. A. M., & Jain, S. K. (2020) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2020.06.029 · Cited by 1
Is it Time to Screen All Patients for Sleep Apnea Before Atrial Fibrillation Ablation?
Ranjan, R. (2020) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2020.06.018 · Cited by 1
Ariyaratnam, J., Sanders, P., & Elliott, A. D. (2022) · Heart Rhythm O2 · doi:10.1016/j.hroo.2022.08.008 · Cited by 1
Self-citationUnderstanding Atrial Fibrillation in the Context of Body Fat Distribution
Tamirisa, K. P., Sanders, P., & Al‐Ahmad, A. (2024) · JACC Advances · doi:10.1016/j.jacadv.2024.100972 · Cited by 1
Self-citationPokorney, S. D., & Piccini, J. P. (2015) · Circulation Cardiovascular Imaging · doi:10.1161/circimaging.115.004202
Pathak, R. K., Elliott, A. D., Mahajan, R., Lau, D. H., & Sanders, P. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.10.069
“We fully agree with the authors that both weight loss and physical exercise are essential components of risk management in overweight and obese subjects: Advocating a fitness-first approach (4), based on treadmill test results similar to those in the current study, might mislead the general public into turning a blind…”
BackgroundSelf-citationElliott, A. D., Pathak, R. K., Mahajan, R., Lau, D. H., & Sanders, P. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.12.041
Self-citationMY APPROACH to obese patients with heart disease
Sanders, P., & Pathak, R. K. (2016) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2015.10.008
“[2] Pathak RK, Middeldorp ME, Lau DH, et al.”
BackgroundSelf-citationExercise Capacity and Atrial Remodeling in Atrial Fibrillation
Lambrakos, L. K., & Goldberger, J. J. (2016) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2016.05.016
Peinado, R., Ruiz‐Mateas, F., Izquierdo, M., Arana‐Rueda, E., Robledo, M. J. L., Arias, M. A., & Chimeno, J. (2016)
Electrophysiology and Health Care Reform
Singh, J. P., & Wilber, D. J. (2015) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2015.09.003
Fragmentation and defragmenting: How to ablate in the age of connectivity?
Gaeta, S. A., & Daubert, J. P. (2016) · Heart Rhythm · doi:10.1016/j.hrthm.2016.09.024
Editorial commentary: Towards improved understanding of atrial fibrillation in South Asians
Mahajan, R., & Lau, D. H. (2016) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2016.12.006
Self-citationPreventing heart failure in atrial fibrillation: In the middle of difficulty lies opportunity
Piccini, J. P., & Steinberg, B. A. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.02.025
“The ARREST trial has demonstrated that targeting risk factors can decrease AF burden and help maintain sinus rhythm.(9) There is good reason to suspect that these interventions should also decrease the risk of HF in these patients.”
BackgroundQuintero-Yepes, V., Duque-Ramírez, M., Abad, P., Zapata, S. I., Duque-González, L., Trespalacios, E. M. V., Díaz-Martínez, J. C., Aristizábal, J. M., & Uribe, W. (2017) · Revista Colombiana de Cardiología · doi:10.1016/j.rccar.2016.11.011
Das Outcome bei der Behandlung von Vorhofflimmern: Alles nur eine Frage von Gewicht und Fitness?
Herrera‐Siklody, C., & Deisenhofer, I. (2017) · Kardiologie up2date · doi:10.1055/s-0042-122792
“[10] Pathak RK, Middeldorp ME, Lau DH et al.”
BackgroundMinimally invasive surgical ablation: Should we ablate harder or smarter?
Callans, D. J., & Kumareswaran, R. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.05.008
Die Pulmonalvenenisolation ist die Primärtherapie bei paroxysmalem Vorhofflimmern
Gonska, B. (2017) · DMW - Deutsche Medizinische Wochenschrift · doi:10.1055/s-0042-108033
Cardiac remodelling in hypertrophic cardiomyopathy and diabesity
Lim, W. (2017) · Adelaide Research & Scholarship (AR&S) (University of Adelaide) · doi:10.4225/55/58b65fe5db46e
Editor-in-Chief's Picks From 2014: Part One
Fuster, V. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.12.021
Blutdruckkontrolle nach Katheterablation von Vorhofflimmern
Fürnkranz, A. (2017) · Der Kardiologe · doi:10.1007/s12181-017-0168-7
Atrial Fibrillation : treatment, associated conditions and quantification of symptoms
Höglund, N. (2017) · DiVA at Umeå University (Umeå University)
Asymptomatic recurrence after AF ablation: Is all lost?
Thiyagarajah, A., Mahajan, R., Lau, D. H., & Sanders, P. (2017) · Indian Pacing and Electrophysiology Journal · doi:10.1016/j.ipej.2017.08.001
Self-citationClinical Management of Atrial Fibrillation
Heist, E. K., MANSOUR, M. C., & Ruskin, J. N. (2017) · Cardiovascular medicine · doi:10.1007/978-3-319-58000-5_15
Metadata
- Authors
- Pathak, R. K., Middeldorp, M. E., Lau, D. H., Mehta, A. B., Mahajan, R., Twomey, D., Alasady, M., Hanley, L., Antic, N. A., McEvoy, R. D., Kalman, J. M., Abhayaratna, W. P., & Sanders, P.
- Affiliations
- Royal Adelaide Hospital (AU)
- Australian National University (AU)
- Flinders University (AU)
- The Royal Melbourne Hospital (AU)
- Corresponding author
- Sanders, Prashanthan
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 64
- Issue
- 21
- Pages
- 2222-2231
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W140098974
- Semantic Scholar
- f4c9c27c3ab3730d2c2ca09e8648704e91ba7fde
- Cited by
- 949
- References
- 44
- Citations by year
- 2026: 57 · 2025: 85 · 2024: 72 · 2023: 73 · 2022: 81 · 2021: 107 · 2020: 97 · 2019: 80 · 2018: 70 · 2017: 92 · 2016: 79 · 2015: 52 · 2014: 4
- FWCI
- 52.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Flinders Academic Commons (Flinders University) (publishedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Flinders Academic Commons (Flinders University) (submittedVersion)
- Funders
- ResMed
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- atrial fibrillation, catheter ablation, cardiovascular risk management, obesity, weight loss, blood pressure reduction, glycemic control, lipid profile, arrhythmia-free survival, atrial fibrillation substrate, antiarrhythmic drugs, atrial fibrillation recurrence
- MeSH terms
- Alcohol Drinking, Atrial Fibrillation, Blood Glucose, Blood Pressure, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Life Style, Lipids, Male, Middle Aged, Recurrence, Risk Factors, Severity of Illness Index, Cohort Studies, Body Mass Index, Case-Control Studies, Smoking Cessation, Catheter Ablation, Sleep Apnea, Obstructive, Dyslipidemias, Weight Reduction Programs
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