Improving outcomes of atrial fibrillation ablation by integrated personalized lifestyle interventions: a randomized controlled trial

Background and Aims Atrial fibrillation (AF) is associated with various lifestyle risk factors. Their presence negatively affects AF catheter ablation outcomes. This study evaluates the efficacy of a nurse-led, integrated lifestyle programme on ablation outcomes. Methods POP-AF is a prospective, randomized, controlled trial involving patients referred for their first AF ablation. Patients were assigned in a 1:1 ratio to standard pre-ablation counselling by the treating electrophysiologist, or a nurse-led integrated lifestyle clinic, including a home sleep apnea test, weight reduction, alcohol reduction, smoking cessation, and optimal hypertension and hypercholesterolemia treatment before undergoing pulmonary vein isolation (PVI). The primary endpoint was a composite of hospitalizations for repeat ablations and direct current cardioversions in an event-rate analysis up to 12 months after pulsed-field PVI. Results A total of 145 patients participated in the trial; 70 patients were assigned to the control group, and 75 patients were assigned to the integrated lifestyle treatment (ILT) group. The median age of patients was 62 years, 26% were women, and 59% had persistent AF. Median ILT duration was 5 months. The primary endpoint occurred 52 times (492/1000 patient-years) in the control group and 25 times (240/1000 patient-years) in the ILT group (incidence relative risk [RR] 0.49, 95% confidence interval [CI] 0.30-0.78, P=0.004). The rates of repeat ablations (RR 0.43, 95% CI 0.18-0.94, P=0.045) and direct current cardioversions (RR 0.52, 95% CI 0.28-0.92, P=0.031) were also lower in the ILT group. Conclusions Integrated lifestyle modification before catheter ablation reduces both repeat ablations and direct current cardioversions by half until 12 months after index ablation.