Beyond rhythm control: burden of modifiable risk factors in patients undergoing catheter ablation for atrial fibrillation

Abstract Background Atrial fibrillation (AF) is one the most common arrhythmias and is associated with increased risk of stroke, heart failure and premature mortality and multimorbidity. Historically, AF management concentrated on stroke prevention and symptom control; however, emphasis has shifted towards the management of modifiable risk factors using a multidisciplinary team approach. Recent guidelines recommend an integrated care model that prioritises risk-factor and comorbidity management as a first step in AF treatment. Purpose To determine the prevalence of modifiable risk factors and comorbidities in patients undergoing AF catheter ablation to inform the development of an integrated, prevention-focused AF care pathway. Methods A retrospective service evaluation audit was conducted using electronic patient records to identify all adults (≥ 18 years old) who underwent catheter ablation across arrhythmia services between 1 January 2024 and 31 December 2024. Descriptive statistics were used to quantify demographic characteristics, procedural details, and the prevalence of comorbidities and modifiable risk factors. Results 200 out of 1406 patients were analysed. Mean age was 63.1 years; 76% were male and 69% were of white ethnicity. Persistent AF accounted for 62% of procedures, and 74.5% of patients underwent first-time ablation arrhythmia recurrence within one year of ablation was observed in 37.5%. The mean body mass index was 29.2 kg/m2 (18.3-46.7 kg/m2), with 42% having BMI≥30 kg/m2. Hypertension was present in 50%, hypercholesterolaemia in 45%, heart failure with reduced ejection fraction in 15%, ischaemic heart disease in 11%, thyroid disease in 12.5%, diabetes mellitus in 10.5%, and obstructive sleep apnoea in 8%. Polypharmacy (≥5 medications) was identified in 46% of patients. Direct oral anticoagulants were prescribed in 95.5% of cases and warfarin in 4%. 28.5% were former smokers, 54% reported never smoking, whilst smoking status was undocumented in 14%. Conclusion Patients undergoing AF ablation demonstrate a high burden of modifiable risk factors and comorbidities. Lifestyle assessment is inconsistently embedded within routine clinical workflows, highlighting significant potential for targeted intervention and supporting the need for structured multidisciplinary prevention strategies alongside rhythm-control approaches. The ongoing challenge remains how best to deliver this care within real-world overburdened healthcare systems.