title: Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY).
abstract: 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.
  
  
  OBJECTIVE
  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 (<3%). Weight trend and/or fluctuation was determined by yearly follow-up. We determined the impact on the AF severity scale and 7-day ambulatory monitoring.
  
  
  RESULTS
  There were no differences in baseline characteristics or follow-up among the groups. AF burden and symptom severity decreased more in group 1 compared with groups 2 and 3 (p < 0.001 for all). Arrhythmia-free survival with and without rhythm control strategies was greatest in group 1 compared with groups 2 and 3 (p < 0.001 for both). In multivariate analyses, weight loss and weight fluctuation were independent predictors of outcomes (p < 0.001 for both). Weight loss ≥ 10% resulted in a 6-fold (95% confidence interval: 3.4 to 10.3; p < 0.001) greater probability of arrhythmia-free survival compared with the other 2 groups. Weight fluctuation >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).
authors: Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors: Rajeev K
authors: RK
authors: Pathak
authors: Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors: Melissa E
authors: ME
authors: Middeldorp
authors: Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors: Megan
authors: M
authors: Meredith
authors: Research School of Finance, Actuarial Studies and Applied Statistics, Australian National University, Canberra, Australia.
authors: Abhinav B
authors: AB
authors: Mehta
authors: Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors: Rajiv
authors: R
authors: Mahajan
authors: Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom.
authors: Christopher X
authors: CX
authors: Wong
authors: Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors: Darragh
authors: D
authors: Twomey
authors: Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; School of Medical Sciences, University of Adelaide, Adelaide, Australia.
authors: Adrian D
authors: AD
authors: Elliott
authors: Department of Cardiology, Royal Melbourne Hospital and the Department of Medicine, University of Melbourne, Melbourne, Australia.
authors: Jonathan M
authors: JM
authors: Kalman
authors: College of Medicine, Biology and Environment, Australian National University and Canberra Hospital, Canberra, Australia.
authors: Walter P
authors: WP
authors: Abhayaratna
authors: Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors: Dennis H
authors: DH
authors: Lau
authors: Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. Electronic address: prash.sanders@adelaide.edu.au.
authors: Prashanthan
authors: P
authors: Sanders
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000628:therapy*; D012720:Severity of Illness Index; D013995:Time; D013997:Time Factors; D015431:Weight Loss
keywords: ablation; atrial fibrillation; cardiac risk factors; obesity; outcomes; remodeling