The effect of weight loss on atrial fibrillation freedom compared to catheter ablation: a sub-analysis of the PRAGUE-25 trial
D Herman, J Vesela, T Roubicek, S Havranek, J Chovancik, V Bulkova, M Hozman, I Ranic, J Hozmanova, M Matoulek, V Tuka, A Latinak, O Jiravsky, F Lehar, P OsmancikAbstract
Background and Aims
In the PRAGUE-25 study, the effect of lifestyle modification (LFM), i.e. weight reduction, alcohol intake reduction, and an increase in physical exercise in combination with antiarrhythmic drugs (AAD) in patients with atrial fibrillation (AF) and BMI 30-40 was smaller than that of catheter ablation (CA). The presented sub-analysis aims to assess the relationship between the actual weight reduction and the AF burden 12 months after randomization.
Methods
This is a per-protocol analysis of the PRAGUE-25 trial. Patients in the LFM+AAD group were stratified into tertiles based on the extent of relative weight reduction, and a comparison of AF burden was performed between the LFM+AAD tertiles and the CA group.
Results
The study analyzed 83 LFM+AAD patients (age 60 ±9 years, 31% women, 54% paroxysmal AF, mean weight 109±17 kg) and 99 CA patients (age 60±9 years, 32% women, 56% paroxysmal AF, mean weight 109±15 kg). Within the LFM+AAD group, 28 patients achieved a weight reduction of >8.3% (−15.46±6.16 kg), 27 patients were between 3.1–8.3% (−6.56±2.28 kg), and 28 patients were <3.1% (+1.38±4.03 kg). Compared to the CA group, the AF burden at 12 months (0 [IQR 0–0]) was significantly higher in the second (3.5% [0; 52] and third (1[0; 47] LFM-ADD tertiles, but did not differ from CA in the first tertile (0% [0; 11.], p=0.17).
Conclusion
The maintenance of SR is related to the level of weight reduction. The effect of significant weight reduction combined with AADs is close to the effect of catheter ablation.