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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]
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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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Cardiometabolic-Based Chronic Disease
Hernández-Sevillano, J., Babagoli, M. A., Mellacheruvu, P., & Mechanick, J. I. (2025) · Springer eBooks · doi:10.1007/978-3-031-82888-1_6
PRIEŠIRDŽIŲ VIRPĖJIMO RIZIKOS VEIKSNIŲ ĮTAKA KATETERINĖS ABLIACIJOS EFEKTYVUMUI
Kmitas, K. (2025) · Health Sciences · doi:10.35988/sm-hs.2025.145
The Importance of Incorporating Lifestyle Modification Into AF Treatment Is Difficult to Measure
Parkash, R., & Piccini, J. P. (2025) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2025.04.065
Ditching the meds: Lifestyle intervention and cardiac arrhythmia
Glover, B., & Hong, K. L. (2017) · doi:10.64628/aam.udcwmjq34
Evaluating if lifestyle interventions are addressed in patients with atrial fibrillation
Isaac, L., Butler, C., & Griffiths, A. (2025) · British Journal of Cardiac Nursing · doi:10.12968/bjca.2025.0002
Cheung, C. C., Chyou, J. Y., Baykaner, T., Elshazly, M. B., Hyman, M. C., Lambrakos, L. K., Lobban, T., Mehta, N. K., Michaud, G. F., Navara, R., et al. (2025) · Heart Rhythm · doi:10.1016/j.hrthm.2025.07.056
Koyama, K., Hashimoto, N., Arimoto, T., Kutsuzawa, D., Watanabe, K., Kobayashi, Y., Toyoshima, M., Kinoshita, D., Wanezaki, M., Otaki, Y., et al. (2025) · Heart Rhythm O2 · doi:10.1016/j.hroo.2025.11.003
“Second, although a previous study suggested that comprehensive risk management contributes to improved clinical outcomes after ablation, 23 this study did not evaluate whether an improvement in NFS leads to a better prognosis.”
Update on first-in-human experience of high-energy ElectroPulse pulsed field ablation
Kakarla, S., Emami, M., Puvrez, A., Young, G. D., Ariyaratnam, J., Kamsani, S. H., Middeldorp, M. E., Stiles, M. K., Wilsmore, B. R., Kistler, P. M., et al. (2025) · Heart Rhythm · doi:10.1016/j.hrthm.2025.10.049
Self-citationAl-U'datt, D. G. F., Mahmoud, D., Tranchant, C. C., Rawashdeh, S., Tashtush, A. A., Almoghrabi, K. S., & Alfwaress, M. F. (2025) · The American Journal of the Medical Sciences · doi:10.1016/j.amjms.2025.11.009
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“44,45 Whether newer ablation modalities such as pulsed field ablation, improved durability of lesions, and other strategies (i.e. imaging) to improve the outcome of PVI plus vs. PVI alone in peAF patients remains to be further explored in randomized controlled trials.”
D’Oro, A., D’Costa, Z. U., Tang, J., Min, S., Jackson, L. R., & Essien, U. R. (2025) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2025.101361
“…with AF, The Aggressive Risk Factor Reduction Study for Atrial Fibrillation (ARREST-AF) demonstrated that patients following catheter ablation were significantly more likely to have arrhythmia-free survival in the cohort undergoing risk factor modification including control of hypertension [84].”
Halle, M., Wimbauer, F., Esefeld, K., & Fegers‐Wustrow, I. (2025) · Springer eBooks · doi:10.1007/978-3-662-69938-6_38
Xiao, J., Persson, A., Engström, G., & Johnson, L. S. B. (2021) · Figshare · doi:10.6084/m9.figshare.14211530
Titus, A., Syeed, S., Baburaj, A., Bhanushali, K. B., Gaikwad, P., Sooraj, M., Saji, A. M., Mir, W. A. Y., Kumar, P. A., Dasari, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.25322960
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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