Risk factor control is essential to reduce the symptom burden and severity of atrial fibrillation. A new study finds that weight loss is a highly effective tool in an overall mitigation strategy.
Atrial fibrillation (AF) is a complex multifactorial disease that has been linked to factors such as alcohol use, obesity, and hypertension. As the incidence of AF continues to grow, one of the most important interventions to control the burden of this disease is risk factor control.
A randomized controlled trial recently published in JAMA demonstrated that weight reduction in addition to management of cardiometabolic risk factors not only reduced the burden of AF and its severity but also resulted in beneficial cardiac remodeling. In this single-center, partially blinded study of 150 patients with symptomatic AF, subjects were followed for a median of 15 months and all participants underwent intensive management of cardiometabolic risk factors. In addition, subjects were randomized to weight management (intervention) or general lifestyle advice (control arm). The primary outcome was assessed based on the Atrial Fibrillation Severity Scale score of symptom burden and severity, which was measured at baseline and every 3 months. Secondary outcomes included total AF episodes, chocardiographic left atrial area, and interventricular septal thickness, measured at baseline and at 12 months.
The intervention group, compared with controls, had a significant reduction in weight (14.3 kg vs 3.6 kg), AF symptom burden and severity scores, number of AF episodes, and cumulative duration of AF (692-minute decline vs 419-minute increase). There was also improvement in indices of cardiac remodeling, such as left atrial area and interventricular septal thickness.
Intensive risk factor management for both groups targeted diabetes, hypertension, sleep apnea, and smoking. However, adding weight reduction to this intensive intervention was highly effective in reducing symptoms and in affecting beneficial cardiac remodeling. This study provides solid evidence that effective weight management should be a therapeutic intervention for every patient with atrial fibrillation.
Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA. 2013;310:2050-2060. doi: 10.1001/jama.2013.280521 (Abstract)