Effect of Weight Reduction and Cardiometabolic Risk Factor Management on Symptom Burden and Severity in Patients With Atrial Fibrillation: A Randomized Clinical Trial

Study Questions:

Can weight loss reduce the burden of atrial fibrillation?

Methods:

This was a single-center, partially blinded, randomized controlled trial (conducted between June 2010 and December 2011), which included overweight and obese patients with symptomatic atrial fibrillation. Patients were randomized to weight management (intervention) or general lifestyle advice (control). Both groups underwent intensive management of cardiometabolic risk factors. The primary outcomes of interest were Atrial Fibrillation Severity Scale scores, which included symptom burden and symptom severity. Scores were measured every 3 months from baseline to 15 months. Secondary outcomes performed at baseline and 12 months were total atrial fibrillation episodes and cumulative duration measured by 7-day Holter, echocardiographic left atrial area, and interventricular septal thickness.

Results:

Of 248 patients screened, 150 were randomized (75 per group) and underwent follow-up. Mean follow-up was 12.9 (95% confidence interval [CI], 12.3-13.5) months in the intervention group and 12.0 (95% CI, 11.1-12.9) months in the control group (median, 15 months for both groups). The intervention group showed a significantly greater reduction in weight (14.3 and 3.6 kg, respectively; p < 0.001) and in atrial fibrillation symptom burden scores (11.8 and 2.6 points, p < 0.001), symptom severity scores (8.4 and 1.7 points, p < 0.001), compared with the control group. Greater reduction in the number of episodes (2.5 and no change, p = 0.01), and cumulative duration (692-minute decline and 419-minute increase, p = 0.002) for the intervention group were also noted. In addition, there was a reduction in interventricular septal thickness in the intervention and control groups (1.1 and 0.6 mm, p = 0.02) and left atrial area (3.5 and 1.9 cm2, p = 0.02).

Conclusions:

The investigators concluded that weight reduction with intensive risk factor management resulted in a reduction in atrial fibrillation symptom burden and severity, as well as in beneficial cardiac remodeling. These findings support therapy directed at weight and risk factors in the management of atrial fibrillation.

Perspective:

This study demonstrated a real benefit to weight reduction as an important therapy for atrial fibrillation. Further study in larger cohorts is warranted.

Clinical Topics: Diabetes and Cardiometabolic Disease

Keywords: Metabolic Syndrome X, Follow-Up Studies, Ventricular Septum, Overweight, Weight Loss, Risk Factors, Obesity, Confidence Intervals


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