Weight loss ≥10% yielded a 6-fold greater probability of arrhythmia-free survival compared with lesser weight loss (95% CI 3.4-10.3; p<0.001), while weight fluctuation >5% increased recurrence risk.
Cohort (n=355)
Does goal-directed weight management reduce AF burden and improve arrhythmia-free survival in obese patients with atrial fibrillation?
Sustained weight loss of ≥10% significantly improves arrhythmia-free survival and reduces AF burden in obese patients with atrial fibrillation.
Effect estimate: 6-fold greater probability (95% CI 3.4 to 10.3)
p-value: p=<0.001
BACKGROUND: Obesity and atrial fibrillation (AF) frequently coexist. Weight loss reduces the burden of AF, but whether this is sustained, has a dose effect, or is influenced by weight fluctuation is unknown. OBJECTIVES: This study sought to evaluate the long-term impact of weight loss and weight fluctuation on rhythm control in obese individuals with AF. METHODS: Of 1,415 consecutive patients with AF, 825 had a body mass index ≥ 27 kg/m(2) and were offered weight management. After screening for exclusion criteria, 355 were included in this analysis. Weight loss was categorized as group 1 (≥ 10%), group 2 (3% to 9%), and group 3 (5% partially offset this benefit, with a 2-fold (95% confidence interval: 1.0 to 4.3; p = 0.02) increased risk of arrhythmia recurrence. CONCLUSIONS: Long-term sustained weight loss is associated with significant reduction of AF burden and maintenance of sinus rhythm. (Long-Term Effect of Goal directed weight management on Atrial Fibrillation Cohort: A 5 Year follow-up study LEGACY Study; ACTRN12614001123639).
Although an older study, the LEGACY trial is experiencing a resurgence in discussion due to the current focus on obesity management and its cardiovascular implications. Its findings on the long-term benefits of sustained weight loss for reducing AF burden are highly relevant to contemporary debates about the holistic management of AF and the role of new obesity treatments.
Pathak et al. (2015) conducted a cohort in Atrial Fibrillation and Obesity (n=355). Weight loss (≥ 10%) vs. Weight loss 3% to 9% or <3% was evaluated on Arrhythmia-free survival (6-fold greater probability, 95% CI 3.4 to 10.3, p=<0.001). Weight loss ≥10% yielded a 6-fold greater probability of arrhythmia-free survival compared with lesser weight loss (95% CI 3.4-10.3; p<0.001), while weight fluctuation >5% increased recurrence risk.