Aggressive Risk factor Reduction Study for Atrial Fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study

Rajeev Pathak, Melissa Middeldorp, Dennis Lau, Abhinav Mehta, Rajiv Mahajan, Darragh Twomey, Muayad Alasady, Lorraine Hanley, Nicholas Antic, Ronald McEvoy, Jonathan Kalman, Walter Abhayaratna, Prashanthan Sanders

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    382 Citations (Scopus)

    Abstract

    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/m2 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.

    Original languageEnglish
    Pages (from-to)2222-2231
    Number of pages10
    JournalJournal of The American College of Cardiology
    Volume64
    Issue number21
    DOIs
    Publication statusPublished - 2 Dec 2014

    Keywords

    • cardiac risk factors
    • catheter ablation
    • follow-up studies
    • obesity
    • outcomes remodeling

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