Results of the LEGACY study show long-term weight loss decreases AF burden and supports sustained sinus rhythm. A short slide show summarizes the 2015 ACC late-breaking abstract.
Background: Incidence of obesity and atrial fibrillation (AF) are both rising in the United States. There is a relationship between obesity and higher risk of AF. This longitudinal study assessed the long-term impact of weight loss as well as weight fluctuation on the burden of AF in obese individuals.
Study methods: 1415 AF patients screened, 825 obese (BMIâ¥27 kg/m2); permanent AF excluded; total population of 355 patients. Structured motivational and goal-directed program with: meal and behavior modification used for achieving at least 3% weight loss (considered significant by ACC/AHA); low-intensity exercise prescribed for 20 minutes TIW then gradually increased to >200 minutes of moderate-intensity exercise per week. Rate or rhythm control drugs at discretion of treating physician; ablation allowed if patient was symptomatic while receiving antiarrhythmic drugs.
To determine dose response, population divided into 3 groups based on amount of weight lost: Group 1 (>10%); Group 2 (3%-9%) and Group 3 (5% weight fluctuation), average (2%-5% weight fluctuation), stable (
Outcomes: Primary: AF burden (AF symptom burden by AF severity scale and freedom from AF by 7-day Holter monitor). Secondary: left atrial volume, left ventricular wall thickness.
Results: Mean follow-up was 46-48 months. Dose-dependent decrease in AF burden and improvement in SBP, lipids, glycemic control, hs-CRP, left atrial volume index, and left ventricular end-diastolic dimension with degree of weight loss (see Table). Group 1 was 6X more likely to be free from AF without ablation or medications. Arrhythmia 2X likely to occur if there was wide (>5%) fluctuation in weight over the year.
1. Weight loss is an essential component of management of the obese patient with AF. Sustained weight loss is associated with a dose-dependent reduction in AF burden and maintenance of sinus rhythm. 2. Wide weight fluctuation increases burden of AF and should be avoided. 3. A physician-led program or weight loss clinic may be an effective strategy for achieving this weight loss, decreasing AF burden, and improving the cardiometabolic risk profile.
The slides above summarize results of the Long-Term Effect of Goal Directed Weight Management on an Atrial Fibrillation Cohort (LEGACY) study. Researchers were interested in the dose-response effect of weight loss on the burden of atrial fibrillation (AF) as well as the impact of sustained vs fluctuating weight loss on AF symptoms. The participant group that had at least a 10% weight loss at 1 year (after a physician-led intervention) had more reductions in severe symptoms than groups that shed fewer pounds. They were also 6 times more likely to achieve arrhythmia-free survival.The results of the study were presented at the 2015 American College of Cardiology Scientific Sessions, Late Breaking Clinical Trials, in San Diego, March 14-16.
Pathak RK, Middeldorp ME, Meredith M, et al. Long-Term Effect of Goal Directed Weight Management in an Atrial Fibrillation Cohort: A Long-term Follow-Up StudY (LEGACY Study). J Am Coll Cardiol. 2015. doi:10.1016/j.jacc.2015.03.002.