Supervised Obesity Reduction Trial for AF Ablation Patients

Results From the SORT-AF Trial

Nele Gessler; Stephan Willems; Daniel Steven; Jens Aberle; Ruken Oezge Akbulak; Nils Gosau; Boris A. Hoffmann; Christian Meyer; Arian Sultan; Roland Tilz; Julia Vogler; PeterWohlmuth; Susanne Scholz; Melanie A. Gunawardene; Christian Eickholt; Jakob Lüker


Europace. 2021;23(10):1548-1558. 

In This Article

Abstract and Introduction


Aims: Weight management seems to be beneficial for obese atrial fibrillation (AF) patients; however, randomized data are sparse. Thus, this study aimed to investigate the influence of weight reduction on AF ablation outcomes.

Methods and results: SORT-AF is an investigator-sponsored, prospective, randomized, multicentre, and clinical trial. Patients with symptomatic AF (paroxysmal or persistent) and body mass index (BMI) 30–40 kg/m2 underwent AF ablation and were randomized to either weight-reduction (group 1) or usual care (group 2), after sleep–apnoea–screening and loop recorder (ILR) implantation. The primary endpoint was defined as AF burden between 3 and 12 months after AF ablation. Overall, 133 patients (60 ± 10 years, 57% persistent AF) were randomized to group 1 (n = 67) and group 2 (n = 66), respectively. Complications after AF-ablation were rare (one stroke and no tamponade). The intervention led to a significant reduction of BMI (34.9 ± 2.6–33.4 ± 3.6) in group 1 compared to a stable BMI in group 2 (P < 0.001). Atrial fibrillation burden after ablation decreased significantly (P < 0.001), with no significant difference regarding the primary endpoint between the groups (P = 0.815, odds ratio: 1.143, confidence interval: 0.369–3.613). Further analyses showed a significant correlation between BMI and AF recurrence for patients with persistent AF compared with paroxysmal AF patients (P = 0.032).

Conclusion: The SORT-AF study shows that AF ablation is safe and successful in obese patients using continuous monitoring via ILR. Although the primary endpoint of AF burden after ablation did not differ between the two groups, the effects of weight loss and improvement of exercise activity were beneficial for obese patients with persistent AF demonstrating the relevance of life-style management as an important adjunct to AF ablation in this setting.

Trial registration number: NCT02064114.


Atrial fibrillation (AF) is the most frequent cardiac arrhythmia in adults. Prevalence of AF tripled over the last 30 years and further progress is expected.[1] Atrial fibrillation is associated with increased mortality and morbidity. Catheter ablation therapy has been proven safe and effective for the treatment of AF and is now a standard therapy.[2]

Obesity is a widespread disease with increasing incidence over the last years in all industrial nations. Being overweight negatively influences cardiovascular risk and leads to progression of arterial hypertension, diabetes mellitus, and coronary artery disease. Therefore, treatment of obesity plays an important role in the prevention of these diseases.[3]

Retrospective and observational studies found a similar relationship in atrial fibrillation (AF) in general[4–6] and particularly regarding the success rate after AF ablation with a higher recurrence rate of AF in patients with obesity or sleep apnoea.[7–9] However, randomized data are sparse. This prospective randomized study aimed to evaluate the role of weight reduction on AF ablation outcomes in obese patients.