title: Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study.
abstract: BACKGROUND
  The long-term outcome of atrial fibrillation (AF) ablation demonstrates attrition. This outcome may be due to failure to attenuate the progressive substrate promoted by cardiovascular risk factors.
  
  
  OBJECTIVE
  The goal of this study was to evaluate the impact of risk factor and weight management on AF ablation outcomes.
  
  
  METHODS
  Of 281 consecutive patients undergoing AF ablation, 149 with a body mass index ≥27 kg/m(2) and ≥1 cardiac risk factor were offered risk factor management (RFM) according to American Heart Association/American College of Cardiology guidelines. After AF ablation, all 61 patients who opted for RFM and 88 control subjects were assessed every 3 to 6 months by clinic review and 7-day Holter monitoring. Changes in the Atrial Fibrillation Severity Scale scores were determined.
  
  
  RESULTS
  There were no differences in baseline characteristics, number of procedures, or follow-up duration between the groups (p = NS). RFM resulted in greater reductions in weight (p = 0.002) and blood pressure (p = 0.006), and better glycemic control (p = 0.001) and lipid profiles (p = 0.01). At follow-up, AF frequency, duration, symptoms, and symptom severity decreased more in the RFM group compared with the control group (all p < 0.001). Single-procedure drug-unassisted arrhythmia-free survival was greater in RFM patients compared with control subjects (p < 0.001). Multiple-procedure arrhythmia-free survival was markedly better in RFM patients compared with control subjects (p < 0.001), with 16% and 42.4%, respectively, using antiarrhythmic drugs (p = 0.004). On multivariate analysis, type of AF (p < 0.001) and RFM (hazard ratio 4.8 [95% confidence interval: 2.04 to 11.4]; p < 0.001) were independent predictors of arrhythmia-free survival.
  
  
  CONCLUSIONS
  Aggressive RFM improved the long-term success of AF ablation. This study underscores the importance of therapy directed at the primary promoters of the AF substrate to facilitate rhythm control strategies.
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Rajeev K
authors.initials: RK
authors.lastname: Pathak
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Middeldorp
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Lau
authors.affiliation: Research School of Finance, Actuarial Studies and Applied Statistics, Australian National University, Canberra, Australia.
authors.forename: Abhinav B
authors.initials: AB
authors.lastname: Mehta
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Mahajan
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Darragh
authors.initials: D
authors.lastname: Twomey
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Research School of Finance, Actuarial Studies and Applied Statistics, Australian National University, Canberra, Australia.
authors.forename: Muayad
authors.initials: M
authors.lastname: Alasady
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Hanley
authors.affiliation: Adelaide Institute for Sleep Health, Repatriation General Hospital and Department of Medicine, Flinders University, Adelaide, Australia.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Antic
authors.affiliation: Adelaide Institute for Sleep Health, Repatriation General Hospital and Department of Medicine, Flinders University, Adelaide, Australia.
authors.forename: R Doug
authors.initials: RD
authors.lastname: McEvoy
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital and the Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
authors.affiliation: College of Medicine, Biology and Environment, Australian National University and Canberra Hospital, Canberra, Australia.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Abhayaratna
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. Electronic address: prash.sanders@adelaide.edu.au.
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
mesh_terms: D000428:Alcohol Drinking; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery*; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D016022:Case-Control Studies; D017115:Catheter Ablation; D015331:Cohort Studies; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000628:therapy; D016540:Smoking Cessation; D061217:Weight Reduction Programs
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids; C517652:hemoglobin A1c protein, human
keywords: cardiac risk factors; catheter ablation; follow-up studies; obesity; outcomes remodeling