Way of life Modifications Scale back AF Recurrence After Ablation

Aggressive way of life and danger issue modification (LRFM) was discovered to considerably cut back the incidence of atrial fibrillation (AF) in symptomatic sufferers with AF present process ablation, in keeping with a brand new research printed in JAMA Cardiology.¹

AF is rising in prevalence and illness burden, as it’s largely influenced by different cardiac danger elements, which embody hypertension, diabetes, weight problems, obstructive sleep apnea, and coronary heart failure.^1,2 Catheter ablation is a widely known, efficient remedy for treating AF, lowering recurrence, and bettering scientific finish factors.¹ Catheter ablation was additionally seen as an efficient remedy for sufferers with coronary heart failure with preserved ejection fraction and AF, however no enchancment was seen in sufferers with coronary heart failure with preserved ejection fraction.²

Modifiable cardiac dangers not solely improve the prevalence of AF but additionally the chance of recurrence. Researchers predicted that with aggressive LFRM, sufferers could cut back their danger of AF development and recurrence by assuaging cardiometabolic comorbidities; nevertheless, extra analysis is required to find out its impression.

The multicenter, open-label, randomized scientific trial ARREST-RF assessed sufferers who underwent consecutive catheter ablation for AF between July 2, 2014, and September 7, 2017, with a 12-month follow-up. Patients had been randomized 1:1 into the LRFM group or the same old care (UC) group. The LRFM group attended a physician-directed LRFM clinic each 3 months. Their blood strain was measured twice day by day at dwelling, they usually acquired a structured, motivational, face-to-face, and goal-directed program for weight discount.

In distinction, the UC group was solely given info on administration of danger, which included written and verbal recommendation on well being, diet, and train tips, however was not enrolled within the LRFM clinic.

LRFM Impact on Patients With AF

The last cohort included 122 sufferers with a imply age of 60 years, of whom 40 had been feminine and 82 had been male. There had been 62 sufferers randomly assigned to the LRFM group and 60 to the UC group.

Twelve months after the catheter ablation, 38 of the 62 sufferers within the LRFM group remained free from atrial arrhythmia, in comparison with the 24 of 60 sufferers within the UC group. The hazard ratio in time-to-event evaluation was 0.53 (95% CI, 0.32-0.89), thus demonstrating a big discount of recurrence within the LRFM group in comparison with the UC group.

AF burden was practically non-existent in each teams. It remained the identical all through all 3 check-in factors throughout the 12-month follow-up. However, repeat ablation was essential for 10 of the 62 sufferers within the LRFM group and 16 of the 60 sufferers within the UC group. At the top of the 12-month follow-up, solely 13 of the 62 LRFM group sufferers reported an absence of any AF-related signs in comparison with the three of 60 within the UC group.

Overall, the burden of signs on account of the catheter ablation was decrease within the LRFM group in comparison with the UC group in regard to symptom frequency (imply distinction, −2.8 factors; 95% CI, −3.8 to −1.9), length (imply distinction, −2.4 factors; 95% CI, −3.5 to −1.2), and episode severity (imply distinction, −0.8; 95% CI, −1.5 to −0.1).

Cardiometabolic danger elements had been extra favorable within the LRFM group, as that they had decrease physique weight, waist circumference, and systolic BP at 12 months in comparison with the UC group.

No critical antagonistic occasions had been seen in both group on the 12-month follow-up. However, 2 sufferers within the LRFM group skilled both procedural pericardial effusion or pseudoaneurysm, whereas 1 affected person within the UC group developed pericarditis. Furthermore, 2 sufferers within the UC group and three sufferers within the LRFM group skilled posterior wall temperature rise, thus limiting catheter ablation.

Next Steps

The research was restricted by its lack of generalizability, because it was performed throughout a number of facilities in Australia. Therefore, its feasibility will not be generalizable to different geographic areas, healthcare methods, or culturally and racially various populations. Furthermore, focused LRFM parts had been broad and subsequently restricted insights into the person contribution of particular danger elements.

“These findings emphasize that beyond the catheter-based intervention, addressing the LRF drivers of progressive remodeling is critical to achieving the highest rate of long-term sinus rhythm maintenance,” the research authors concluded.

References

1. Pathak RK, Elliott AD, Lau DH, et al. Aggressive danger issue discount research for atrial fibrillation implications for ablation outcomes: the ARREST-AF randomized scientific trial. JAMA Cardiol. Published on-line October 29, 2025. doi:10.1001/jamacardio.2025.4007

2. Oraii A, McIntyre WF, Parkash R, et al. Atrial fibrillation ablation in coronary heart failure with diminished vs preserved ejection fraction: a scientific overview and meta-analysis. JAMA Cardiol. 2024;9(6):545–555. doi:10.1001/jamacardio.2024.0675