Progression of atrial fibrillation from paroxysmal to persistent was reversed in 88% of obese patients when they achieved weight loss of more than 10%, South Australian research has shown.
Atrial fibrillation is usually a progressive disease but researchers from Centre for Rhythm Disorders (CHRD) at the SA Health and Medical Research Institute found a dose-response relationship between weight loss and progression of AF in a trial of weight loss management.
In an earlier LEGACY (Long Term Effect of Goal-Directed Weight Management in an AF Cohort) study involving 1415 patients with AF they showed that intensive weight loss and risk factor management was associated with long term freedom from AF in obese people.
In a follow up analysis of 355 obese (BMI >27) patients who attended physician-supervised weight loss clinics they found that among the 116 who achieved little or no weight loss (less than 3%), 41% progressed from paroxysmal to persistent AF and 26% reversed from persistent to paroxysmal or no AF.
In contrast, of the 135 patients who achieved a target weight loss of more than 10%, only 3% progressed to persistent AF while 88% reversed from persistent to paroxysmal or no AF.
Of the 104 AF patients in the intermediate group who achieved 3-9% weight loss, 32% showed AF progression and 49% reversed progression.
Increased weight loss was also associated with greater rates of AF freedom – 86% in those who achieved target weight loss, 67% among those who achieved intermediate weight loss and 39% in those with modest or no weight loss.
Publishing their findings in the Europace journal of the European Society of Cardiology, the researchers said they added to the growing body of evidence that risk factor management can halt the so-called “AF begets AF” vicious cycle of AF progression.
Progression of AF appeared to be promoted by an atrial substrate that is linked to cardiac risk factors such as obesity, they suggested.
“The recognition of AF as a progressive disease, determined by ongoing remodelling consequent to the various underlying risk factors, calls for early and aggressive weight and risk factor intervention,” they wrote.
“Given the rising epidemic of obesity and AF, primary and secondary prevention strategies need to be urgently implemented.”