Weight Loss Improves Atrial Fibrillation, Cardiometabolic Profile

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 (BMI≥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.