Aggressive Risk Factor Reduction Benefits AF Patients After Ablation

Summary and Comment |
December 18, 2014

Aggressive Risk Factor Reduction Benefits AF Patients After Ablation

  1. Mark S. Link, MD

This successful intervention reduced AF recurrence by focusing on weight, blood pressure, lipids, blood sugar, and sleep apnea.

  1. Mark S. Link, MD

Catheter ablation has become standard therapy for individuals with atrial fibrillation (AF) despite less-than-ideal success rates and frequent AF recurrence. Although advancements in catheter techniques have improved outcomes, AF recurrence remains high. Certain clinical characteristics clearly increase the risk for AF. Many of these also increase the risk for AF recurrence after ablation. Researchers in Australia now report on the ARREST-AF cohort study results on aggressive risk reduction after AF ablation.

Of 281 consecutive patients undergoing AF ablation, 149 had a body-mass index (BMI) ≥27 kg/m2 and ≥1 cardiac risk factor and entered the study. Of these patients, 61 opted for aggressive risk factor management (RFM) provided according to American Heart Association (AHA) guidelines (NEJM JW Cardiology Sep 6 2002), and 88 received standard follow-up. Aggressive RFM included participation in a physician-directed RFM clinic every 3 months. The goal of blood pressure control was <130/80. The weight reduction intervention used face-to-face motivational, goal-directed counseling aiming to reduce body weight by 10%. Lipids and glycemic control were aggressively managed. Sleep-disordered breathing management and counseling for control of smoking and alcohol were provided to all patients with these issues.

The mean follow-up was about 41 months. Weight, BMI, mean systolic blood pressure, and diabetic control improved more with aggressive RFM than with standard treatment. Recipients of aggressive RFM showed marked improvements in AF frequency, duration, and severity compared with control participants.

Comment

Aggressive risk factor modification, such as is called for by AHA guidelines, may also reduce the recurrence of AF after ablation. Although these patients were self-selected for the intervention, it is reasonable, based on these results, other data, and AHA guidelines to aggressively control weight, blood pressure, lipids, blood sugar, and sleep apnea. An editorialist congratulates the authors for applying aggressive RFM rigorously and demonstrating its beneficial effects.

Editor Disclosures at Time of Publication

  • Disclosures for Mark S. Link, MD at time of publication Grant / Research support Unequal Technologies Editorial boards UpToDate

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