A randomized comparison of comprehensive weight loss intervention vs. usual care on recurrences of atrial fibrillation in obese patients after catheter ablation: HOBIT-AF trial
Kristýna Koščálová, Peter Novodvorský, Iva Jakubíková, Adam Ševčík, Adam Rafaj, Iveta Pleyerová, Kristýna Heidu, Jakub Štoček, Helena Kratochvílová, Luděk Horváth, Miloš Mráz, Jan Mareš, Dan Wichterle, Josef Kautzner, Martin HaluzíkAbstract
Aims
Obesity is one of the strongest risk factors for the development of atrial fibrillation (AF), and its reduction is associated with the alleviation of AF burden. The HOBIT-AF study aimed to evaluate the impact of complex weight loss interventions on AF recurrence rate in obese individuals after catheter ablation (CA).
Methods and results
The HOBIT-AF was a randomized controlled trial with a 15-month treatment period (3–18 months post CA) involving complex weight-reducing interventions in the active arm. The primary outcome was the change in AF/atrial tachycardia (AT) burden assessed from baseline and the final 14-day Holter monitoring. A total of 167 individuals (aged 59 years, body mass index of 35.6 kg/m2) were randomized into the active (n = 85) and control group (n = 82). At the end of the treatment period, a mean reduction of 6.8 ± 7.0% of the initial body weight accompanied by improvement of metabolic parameters was achieved in the active group. The AF/AT burden change was 0.6 ± 2.5% (95% CI: −4.2–5.5%) in the active group and −0.9 ± 1.8% (95% CI: −4.5–3.0%) in the control group. The AF/AT recurrence-free survival during the 3–18-month follow-up period was comparable between groups (70.4% vs. 69.6%).
Conclusion
HOBIT-AF trial showed that despite the beneficial effect of body weight reduction on metabolic profile of obese patients with predominantly paroxysmal AF after CA, no reduction in AF/AT recurrence was observed in comparison with control patients. This may be likely due to low AF burden after previous CA, limiting further improvement.