Weight Loss, Risk Management May Reverse Atrial Fibrillation Progression

Patrice Wendling

May 10, 2016

SAN FRANCISCO, CA — Weight loss and aggressive risk factor management can alter atrial fibrillation (AF) disease progression in overweight or obese patients, results of a new study suggest[1].

The Prevention and Regressive Effect of Weight Loss and Risk Factor Modification on Atrial Fibrillation (REVERSE-AF) study examined the impact of obesity and weight loss on AF progression in 355 AF patients with a body-mass index (BMI) >27 kg/m2. It found that only 3% of patients with sustained weight loss >10% progressed from paroxysmal to persistent AF compared with 32% who lost 3% to 9% and 48% who lost <3% (P<0.001).

At the same time, 36% of patients with >10% weight loss had AF reversed from persistent to paroxysmal vs 17% in group 2 and 1% in group 3 (P<.001), lead investigator Ms Melissa Middeldorp (University of Adelaide and Royal Adelaide Hospital, Australia) reported at the Heart Rhythm Society (HRS) 2016 Scientific Sessions.

Previous studies have shown the benefit of weight loss and lifestyle changes on AF symptom burden. "This, however, is showing the additive effect of actually reversing the disease and the substrate that may be causing that," she told heartwire from Medscape.

REVERSE-AF is the third study in a little over a year to support the benefits of weight loss and risk reduction in the management of AF. Last March, the Australian team also demonstrated a significant dose-response effect of weight reduction on AF symptom burden in the LEGACY trial. The data was quickly followed by the CARDIO-FIT trial showing that increased cardiorespiratory fitness is linked to a dose-dependent reduction in AF symptoms and also predicts recurrence in obese patients.

Middeldorp said with the rising tide of obesity, a continual increase in the conditions and AF associated with it can be expected. "So dealing with the root of the problem is a very important factor and should be established in all clinics around the world."

After the publication of LEGACY, however, some argued that a randomized trial is needed to evaluate the real effect of weight loss on AF, citing several potential sources of selection bias in the study, including greater dietary counseling participation in patients with the highest weight loss, older age in this group, and a lack of details on comorbidities, AF treatments, and study dropouts.

For REVERSE-AF, the 355 patients were drawn from 825 of 1415 consecutive patients who had a BMI >27 kg/m2. Exclusions included 10 patients with terminal cancer, 20 with inflammatory diagnoses that might affect the AF substrate, 77 with severe medical illnesses, 84 with permanent AF, 90 with previous AF ablation, 12 with previous AV node ablation, and 177 patients from other centers without sufficient follow-up, Middeldorp said.

The patients had similar baseline characteristics and all underwent aggressive, tailored risk management including weight counseling and exercise in a protocol in press in the European Heart Journal.

Baseline Characteristics

Characteristic <3% weight loss (n=116) 3%–9% weight loss (n=104) > 10% weight loss (n=135) P
Age (y) 61 63 65 0.06
BMI, kg/m2 32.9 32.7 33.6 0.24
Hypertension (%) 78 73 81 0.30
Diabetes (%) 29 27 30 0.35
Hyperlipidemia (%) 48 44 49 0.70
CAD (%) 9 12 16 0.31
Paroxysmal AF (%) 53 60 54 0.55

Increasing weight loss resulted in a dramatic decline in the need for ablation, although the number of patients requiring AV node ablation or pacemaker implantation was similar between groups, Middeldorp said.

Results

Outcome <3% weight loss (n=116),% 3%–9% weight loss (n=104), % >10% weight loss (n=135), % P
Ablation 87 78 54 0.03
AV node ablation 5 5 4 0.9
Pacemaker implantation 38 34 27 0.08

For every one-unit decline in body mass index, there was a 54% reduction in progression from paroxysmal to persistent AF (odds ratio 0.46, 95% CI 0.35–0.59) and a 71% increase in regression from persistent to paroxysmal AF (OR 1.71, 95% CI 1.41–2.07), she said.

"Weight loss and risk-factor management are essential components in the treatment of atrial fibrillation to alter AF disease progression," she concluded.

The authors reported no relevant financial disclosures.

Follow Patrice Wendling on Twitter: @pwendl.For more from theheart.org, follow us on Twitter and Facebook.

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