Unlock the Secret Link Between Weight Loss and Atrial Fibrillation – What You Need to Know!

Introduction

Atrial fibrillation (AFib) stands as the most prevalent sustained arrhythmia affecting adults, significantly elevating the risks of stroke, dementia, and overall mortality. Several factors contribute to the development of AFib, including hypertension, diabetes, obesity, and obstructive sleep apnea. Catheter ablation is a recognized treatment method to prevent recurrence of AF, especially for drug-refractory symptomatic AF. Obesity, a global health concern, is strongly linked to AFib incidence, influencing both its occurrence and prognosis, including outcomes following catheter ablation, a common procedure aimed at restoring normal heart rhythm. Research indicates that weight loss can mitigate AFib incidence and its burden in obese individuals. This article explores the intricate relationship between weight loss and AFib, synthesizing findings from clinical trials and observational studies to provide a comprehensive understanding of the impact of weight management on AFib outcomes, particularly after ablation.

The Obesity-AFib Connection

Obesity is an strong risk factor for atrial fibrillation (AF), and obesity can affect the prognosis of AF. Research over the last decade has shown a strong association between AFib and obesity, which is defined as body mass index (BMI) of 30 or higher. Adults have obesity, speeding toward 50% or more by 2030. Between 3 and 6 million have AFib, an irregular heartbeat, with that number expected to more than double by 2030. Overweight and obesity have an adverse effect on cardiovascular prognosis in long-term follow-up, and the guidelines showed obesity increases the risk of AF progressively.

Weight Loss and AFib Recurrence After Ablation: Evidence from Studies

Clinical Trial Findings

One randomized, open-labeled clinical trial and seven cohort studies involving 1283 patients were included. The mean body mass index of all included studies was over 30 kg/m2.

The clinical trial (SORT-AF) showed that the intervention group achieved a mean percentage weight loss of 3.91% compared with 0.91% in the control group, demonstrating that weight loss did not significantly reduce the recurrence rate of AF after ablation (OR = 1.02, 95% CI 0.70-1.47) after 12 months of follow-up.

Observational Study Insights

Meta-analysis based on observational studies showed that the recurrence rate of AF after ablation was significantly reduced (RR = 0.43, 95% CI 0.22-0.81, I2 = 97%) in relatively obese patients with weight loss compared with the control group.

Among the observational studies, the mean BMI was over 30 kg/m2 in all studies, and six studies were based on patients with obesity. Four articles showed a lower AF recurrence rate after ablation of weight loss, whereas the remaining three reported no significant association. The pooled results of observational studies showed that weight loss in relatively obese patients was associated with a significant risk of AF relapse after ablation (RR = 0.43.95% CI 0.22-0.81) with substantial heterogeneity (Q statistic: P < 0.00001; I2 = 97%).

Dose-Response Relationship

Each 10% reduction in weight was associated with a decreased risk of AF recurrence after ablation (RR = 0.54, 95% CI 0.33-0.88) with high statistical heterogeneity (I2 = 76%). A pooled analysis from seven cohort studies showed a significant association between each 10% weight loss and AF recurrence rates after ablation (RR = 0.54, 95% CI 0.33-0.88) with high statistical heterogeneity (Q statistic: P = 0.0003; I2 = 76%). The nonlinear dose-response association was fitted by the restricted cubic splines function, showing a significant trend of inverse association (Pnon-linearity = 0.27) of AF relapse after ablation with increasing weight loss. However, the results were merely significant at a range of 6-13% weight loss.

Subgroup Analysis: Weight Loss Method

The results showed that bariatric surgery was associated with lower AF relapse after ablation (bariatric surgery, RR = 0.14, 95% CI 0.12-0.17). However, although a nonsignificant association was noted for lifestyle management (lifestyle management, RR = 0.56, 95% CI 0.18-1.69). a significant decreasing trend was observed (Additional file 1: Figure S1A). Similar results were found for each 10% reduction in different weight loss method (bariatric surgery, RR = 0.39, 95% CI 0.24-0.64, lifestyle management, RR = 0.58, 95%: 0.21-1.59), with substantial heterogeneity (Q statistic: P < 0.0007; I2 = 82%).

Pre-defined subgroup analysis stratified by the weight loss time showed that weight loss was associated with lower AF relapse when patients receive weight management before ablation (RR = 0.41; 95% CI 0.19-0.92). However, when patients received weight management after ablation, the weight loss did not significantly decrease AF recurrence (RR = 0.46, 95% CI 0.19-1.14), with no significant subgroup difference (P = 0.86).

Weight Loss and AFib Severity, Symptoms, and Quality of Life

Evidence from the observational study showed that weight loss was significantly associated with reduced duration and symptoms of AF (P < 0.001). Mohanty et al. showed that AF weight loss significantly improved quality of life (P < 0.002) but not the symptom severity of AF (P = 0.84).

Weight Management Programs: A Comprehensive Approach

Managing the complex conditions of obesity and AFib requires an evidence-based, personalized treatment strategy. Simply telling patients to “eat less and move more” isn’t effective. Specialists from UT Southwestern’s Heart Rhythm Management team and Weight Wellness Program have joined forces to start a first-of-its-kind Atrial Fibrillation Wellness Program that addresses the dual risk factors for patients with AFib and obesity. Led by board-certified cardiologists and obesity medicine specialists, our comprehensive care team will offer patients treatments that will include the latest and most effective anti-obesity medications, nutritional counseling, mental health care, exercise, and much more - all with the purpose of addressing both diseases to improve your cardiovascular health and quality of life.

Lifestyle Changes for AFib Management

Losing weight and keeping it off reduces atrial fibrillation burden and improves maintenance of sinus rhythm. The study was conducted by the Centre for Heart Rhythm Disorders at Australia’s University of Adelaide and Royal Adelaide Hospital. Dr. Rajeev K. Dr. Pathak and his team followed 355 afib patients with a body mass index (BMI) of 27 or higher (BMI of 30 indicates obesity). All were offered access to a physician-led weight management clinic. Results showed that afib burden and symptom severity decreased more among patients who lost and kept off at least 10 percent of their initial weight than among those with a weight loss of 3-9 percent or whose weight fluctuated significantly during the study period. The greater the weight loss, the better the effect on structural remodeling, as indicated by reduction in the size of the left atrium, and on inflammation, as measured by high-sensitivity C-Reactive Protein (hs-CRP). While the LEGACY Study shows only an association between weight loss and reduced afib burden, Dr. Pathak said that a randomized clinical trial is necessary to prove that weight loss causes a decrease in afib symptoms. The study is the first to track the long-term effects of weight loss and the degree of weight fluctuation on atrial fibrillation burden. Patients who lost more weight and maintained a more stable weight over four years showed marked reductions in atrial fibrillation burden and severity, the study’s primary endpoints.

“Previous studies have shown that weight management can reduce atrial fibrillation symptoms in the short term and improve outcomes of ablation [a surgical treatment for atrial fibrillation],” said Rajeev Pathak, M.D., a cardiologist and electrophysiology fellow at the University of Adelaide, Adelaide, Australia and the study’s lead author. Researchers enrolled 355 participants in a dedicated weight loss clinic and tracked their health annually for an average of four years. All participants were obese and had atrial fibrillation at the start of the study. To encourage weight loss, the clinic used a motivational, goal-directed approach that included three in-person visits per month, detailed dietary guidance, low-intensity exercise, support counseling and maintenance of a daily diet and physical activity diary. Participants returned to the clinic annually for a health exam and atrial fibrillation monitoring. To assess the frequency, duration and severity of symptoms, patients completed questionnaires and wore a Holter monitor, a machine that tracks the heart’s rhythms, for seven days. After an average of four years, 45 percent of patients who lost 10 percent or more of their body weight and 22 percent of patients who lost 3 to 9 percent of their weight achieved freedom from atrial fibrillation symptoms without the use of any atrial fibrillation surgery or medication. Only 13 percent of patients who lost less than 3 percent of their body weight were free of symptoms without these treatments. Even with the use of surgery or medication, those who lost more weight were substantially more likely to achieve freedom from atrial fibrillation symptoms.

Sustained weight management and a linear weight loss trajectory were also associated with greater freedom from atrial fibrillation. Patients who lost and then regained weight, causing a fluctuation of more than 5 percent between annual visits, were twice as likely to have recurrent rhythm problems than those who did not experience such fluctuations. Weight loss was also associated with significant beneficial structural changes in the heart and significantly improved other markers of heart health including blood pressure, cholesterol and blood sugar levels.

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