"Lifting heart's burden": SORT-AF study shows losing weight decreases AF recurrence.

Weight management seems to be beneficial for obese atrial fibrillation (AF) patients; however, no randomised trials have yet been conducted to prove this. Gessler et al in the latest issue of EP Europace journal have presented for the first time robust evidence from a randomised trial showing weight loss and improvement of exercise activity as beneficial lifestyle changes which prevent arrhythmia recurrence in obese patients post AF (persistent type) ablation.

Retrospective and observational studies have found higher recurrence rate of AF in patients with obesity or sleep apnea post ablation. This prospective randomised study aimed to evaluate the role of weight reduction on AF ablation outcomes in obese patients.

Patients with symptomatic AF (paroxysmal or persistent) and Body-Mass-Index (BMI) 30-40kg/m2 underwent AF-ablation and were randomised to either weight-reduction (group-1) or usual care (group-2), after sleep-apnea-screening and loop recorder (ILR) implantation. The primary endpoint was defined as AF-burden between 3-12 months after AF-ablation.

The lifestyle interventions led to a significant reduction of BMI (34.9±2.6 to 33.4±3.6) in group-1 compared to a stable BMI in group-2 (p < 0.001). AF-burden after ablation decreased significantly (p < 0.001), with no significant difference regarding the primary endpoint between the groups, but further analyses showed a significant correlation between BMI and AF-recurrence for patients with persistent AF compared to paroxysmal AF patients.

The SORT-AF study shows that AF-ablation is safe and successful in obese patients using continuous monitoring via ILR. Subsequent analysis also showed that weight loss and improvement in exercise activity is beneficial for obese persistent AF patients with respect to freedom from recurrence

Previous observational studies including the landmark LEGACY study, report that sustained weight loss is associated with a significant reduction in AF burden measured by annual 7-day Holter monitoring. The CARDIO-FIT study observed the same effect on AF for improvement of exercise capacity.

Also Read:Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY)

Also Read:Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation: The CARDIO-FIT Study

A reason for the positive effect of weight reduction particularly in persistent AF patients might be the observed association of obesity with a more advanced atrial substrate. Recently, Mahajan et al reported weight reduction to be associated with structural and electrophysiological reverse remodeling and a reduced propensity for AF.

The "SORT-AF" - Supervised Obesity Reduction Trial for AF Ablation Patients – study is the first randomised clinical trial to evaluate the effect of weight loss with a structured weight reduction program on the success rate of AF ablation in obese patients. Furthermore, the SORT-AF study proved AF ablation to be safe and successful in obese patients.

Source: EP Europace: euab122, https://doi.org/10.1093/europace/euab122