Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study - PubMed (original) (raw)

. 2014 Dec 2;64(21):2222-31.

doi: 10.1016/j.jacc.2014.09.028. Epub 2014 Nov 24.

Melissa E Middeldorp 1, Dennis H Lau 1, Abhinav B Mehta 2, Rajiv Mahajan 1, Darragh Twomey 1, Muayad Alasady 3, Lorraine Hanley 1, Nicholas A Antic 4, R Doug McEvoy 4, Jonathan M Kalman 5, Walter P Abhayaratna 6, Prashanthan Sanders 7

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Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study

Rajeev K Pathak et al. J Am Coll Cardiol. 2014.

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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/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.

Keywords: cardiac risk factors; catheter ablation; follow-up studies; obesity; outcomes remodeling.

Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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