Weight-loss management after catheter ablation of atrial fibrillation

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. INTRODUCTION: Overweight and obesity are modifiable risk factors for atrial fibrillation (AF). Pulmonary vein isolation (PVI) is a cornerstone therapy of AF, however elevated body mass index (BMI) is associated with higher AF recurrence rate. Weight loss in patients with increased BMI can improve ablation outcomes, however data on weight loss management after PVI is lacking. PURPOSE: To determine impact of weight loss in overweight and obese patients before PVI and to determine BMI trends after PVI. METHODS: Consecutive patients with baseline BMI >25 who underwent PVI were included into the study. All patients received comprehensive and intensive dietary and lifestyle modification recommendations. Anthropometric measurements were taken at initial visit (pre-PVI), on the day of ablation (PVI) and at the end of follow-up (post-PVI). RESULTS: 60 patients (25 female, age 59±11 years) were included into the study. Mean achieved weigh loss was before PVI was 2±4 kg (pre-PVI vs PVI, 85.3 kg vs 83.3 kg, p=0.31). During follow up lasting 15±13 months 29 patients (48%) remained AF-free. Seventeen patients (28%) gained ≥1kg from baseline and these patients were more likely to experience AF recurrence when compared to these patients who managed to sustained their weigh (76% vs 42%, p=0.0065). Thirty-one (52%) patients who managed to sustain weight loss ≥2kg from baseline were more likely to remain AF-free during follow-up (69% vs 35%, p=0.038). There was no statistically significant difference between weight at baseline vs after follow-up (pre-PVI vs post-PVI, 85.3 kg vs 83.4 kg, p=0.36). CONCLUSIONS: A substantial portion of patients can experience weight regain after PVI. Weight regain is associated with increased risk of AF recurrence following catheter ablation of AF. In patients with elevated BMI periprocedural risk factor modification resulting in weight loss is associated with improved AF-free survival. [Figure: see text]