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Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort
Open accessAbstract
Background Obesity and atrial fibrillation (AF) frequently coexist. Weight loss reduces the burden of AF, but whether this is sustained, has a dose effect, or is influenced by weight fluctuation is unknown.Objectives This study sought to evaluate the long-term impact of weight loss and weight fluctuation on rhythm control in obese individuals with AF.Methods Of 1,415 consecutive patients with AF, 825 had a body mass index ≥ 27 kg/m(2) and were offered weight management. After screening for exclusion criteria, 355 were included in this analysis. Weight loss was categorized as group 1 (≥ 10%), group 2 (3% to 9%), and group 3 (<3%). Weight trend and/or fluctuation was determined by yearly follow-up. We determined the impact on the AF severity scale and 7-day ambulatory monitoring.Results There were no differences in baseline characteristics or follow-up among the groups. AF burden and symptom severity decreased more in group 1 compared with groups 2 and 3 (p < 0.001 for all). Arrhythmia-free survival with and without rhythm control strategies was greatest in group 1 compared with groups 2 and 3 (p < 0.001 for both). In multivariate analyses, weight loss and weight fluctuation were independent predictors of outcomes (p < 0.001 for both). Weight loss ≥ 10% resulted in a 6-fold (95% confidence interval: 3.4 to 10.3; p < 0.001) greater probability of arrhythmia-free survival compared with the other 2 groups. Weight fluctuation >5% partially offset this benefit, with a 2-fold (95% confidence interval: 1.0 to 4.3; p = 0.02) increased risk of arrhythmia recurrence.Conclusions Long-term sustained weight loss is associated with significant reduction of AF burden and maintenance of sinus rhythm. (Long-Term Effect of Goal directed weight management on Atrial Fibrillation Cohort: A 5 Year follow-up study [LEGACY Study]; ACTRN12614001123639).
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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 [167]
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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 [296]
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Ablation of Atrial Fibrillation
Link, M. S., Haı̈ssaguerre, M., & Natale, A. (2016) · Circulation · doi:10.1161/circulationaha.116.021727 · Cited by 64
Homan, E. A., Reyes, M. V., Hickey, K. T., & Morrow, J. (2019) · Frontiers in Physiology · doi:10.3389/fphys.2018.01847 · Cited by 63
Impact of Bariatric Surgery on Atrial Fibrillation Type
Donnellan, E., Wazni, O. M., Elshazly, M. B., Kanj, M. H., Hussein, A. A., Baranowski, B. J., Kochar, A., Trulock, K. M., Aminian, A., Schauer, P. R., et al. (2020) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.119.007626 · Cited by 62
Lifestyle Modification in the Prevention and Treatment of Atrial Fibrillation
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The why, when and how to test for obstructive sleep apnea in patients with atrial fibrillation
Desteghe, L., Hendriks, J., McEvoy, R. D., Chai‐Coetzer, C. L., Dendale, P., Sanders, P., Heidbüchel, H., & Linz, D. (2018) · Clinical Research in Cardiology · doi:10.1007/s00392-018-1248-9 · Cited by 59
Coronary Endothelial Dysfunction Is Associated With Increased Risk of Incident Atrial Fibrillation
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Association of Body Mass Index With Care and Outcomes in Patients With Atrial Fibrillation
Pandey, A., Gersh, B. J., McGuire, D. K., Shrader, P. J., Thomas, L. E., Kowey, P. R., Mahaffey, K. W., Hylek, E. M., Sun, S., Burton, P. B. J., et al. (2015) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2015.12.001 · Cited by 59
Hendriks, J., Tieleman, R. G., Vrijhoef, H. J., Wijtvliet, P., Gallagher, C., Prins, M. H., Sanders, P., & Crijns, H. J. G. M. (2019) · EP Europace · doi:10.1093/europace/euz209 · Cited by 58
Hajj, E. C. E., Hajj, M. C. E., Sykes, B., Lamicq, M., Zile, M. R., Malcolm, R., O’Neil, P. M., & Litwin, S. E. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.121.022930 · Cited by 58
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The Impact of Diet and Lifestyle on Atrial Fibrillation
Nalliah, C. J., Sanders, P., & Kalman, J. M. (2018) · Current Cardiology Reports · doi:10.1007/s11886-018-1082-8 · Cited by 63
Gunawardene, M., & Willems, S. (2021) · EP Europace · doi:10.1093/europace/euab257 · Cited by 56
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Risk factor management and atrial fibrillation
Hendriks, J., Gallagher, C., Middeldorp, M. E., Lau, D. H., & Sanders, P. (2020) · EP Europace · doi:10.1093/europace/euaa346 · Cited by 56
Relations of Liver Fat With Prevalent and Incident Atrial Fibrillation in the Framingham Heart Study
Long, M. T., Yin, X., Larson, M. G., Ellinor, P. T., Lubitz, S. A., McManus, D. D., Magnani, J. W., Stærk, L., Ko, D., Helm, R. H., et al. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.116.005227 · Cited by 55
Relation of Obesity to New-Onset Atrial Fibrillation and Atrial Flutter in Adults
Foy, A., Mandrola, J. M., Liu, G., & Naccarelli, G. V. (2018) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2018.01.019 · Cited by 56
Mechanisms of Long-Term Recurrence 3 Years After Catheter Ablation of Atrial Fibrillation
Park, J., Yu, H. T., Kim, T., Uhm, J., Joung, B., Lee, M., & Pak, H. (2020) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2020.04.035 · Cited by 53
Atrial fibrillation in patients with diabetes: molecular mechanisms and therapeutic perspectives.
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Advancing Research on the Complex Interrelations Between Atrial Fibrillation and Heart Failure
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Targeting the Substrate for Atrial Fibrillation
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Molecular mechanisms of atrial fibrosis: implications for the clinic
Thanigaimani, S., Lau, D. H., Agbaedeng, T. A., Elliott, A. D., Mahajan, R., & Sanders, P. (2017) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2017.1299005 · Cited by 50
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Ariyaratnam, J., Elliott, A. D., Mishima, R. S., Gallagher, C., Lau, D. H., & Sanders, P. (2021) · Heart Rhythm O2 · doi:10.1016/j.hroo.2021.09.015 · Cited by 52
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Metadata
- Authors
- Pathak, R. K., Middeldorp, M. E., Meredith, M., Mehta, A. B., Mahajan, R., Wong, C. X., Twomey, D., Elliott, A. D., Kalman, J. M., Abhayaratna, W. P., Lau, D. H., & Sanders, P.
- Affiliations
- Royal Adelaide Hospital (AU)
- Australian National University (AU)
- The Royal Melbourne Hospital (AU)
- Corresponding author
- Sanders, Prashanthan
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 65
- Issue
- 20
- Pages
- 2159-2169
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2102904190
- Cited by
- 1,036
- References
- 34
- Citations by year
- 2026: 97 · 2025: 100 · 2024: 91 · 2023: 95 · 2022: 73 · 2021: 108 · 2020: 97 · 2019: 96 · 2018: 73 · 2017: 85 · 2016: 81 · 2015: 39
- FWCI
- 66.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Funders
- Lions Medical Research Foundation
- National Heart Foundation of Australia
- University of Adelaide
- Rhodes College
- National Health and Medical Research Council
- Centre for Heart Rhythm Disorders, University of Adelaide
- 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, obesity, weight loss, weight variation, arrhythmia burden, rhythm control, arrhythmia-free survival, sinus rhythm maintenance, body mass index
- MeSH terms
- Aged, Atrial Fibrillation, Female, Follow-Up Studies, Goals, Humans, Male, Middle Aged, Obesity, Severity of Illness Index, Time, Time Factors, Weight Loss
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