Table 3: Studies Investigating Risk Factor Management for Secondary Atrial Fibrillation Prevention.
| Study | Design | Subjects n (% women) | AF | Follow-up (months) | Intervention | Outcomes |
|---|---|---|---|---|---|---|
| Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation[162] | Prospective, randomised controlled study | 150 (33 %) | Paroxysmal or persistent AF, BMI ≥27 kg/m2 | 15 | Structured weight management versus general lifestyle advice | Significantly greater reduction in weight (14.3 versus 3.6 kg); AF symptom burden scores (11.8 versus 2.6 points); symptom severity scores (8.4 versus 1.7 points); AF episodes (2.5 versus no change); cumulative AF duration (692 min decline versus 419 min increase) |
| LEGACY164 | Prospective observational cohort study | 355 (34 %) | Paroxysmal or persistent AF, BMI ≥27 kg/m2 | 60 | Structured weight management; tailored risk-factor management | Significantly greater decrease in AF burden and symptom severity in WL ≥10 %; WL ≥10 % with sixfold greater probability of freedom from AF; weight fluctuation >5 % with twofold increased AF recurrence |
| BMI Reduction Decreases AF Recurrence Rate in a Mediterranean Cohort[166] | Retrospective cohort study | 258 (n/r) | Paroxysmal or permanent AF; BMI >25 kg/m2 | 602 patient-years (overall) | Diet and/or moderate exercise | AF recurrence most frequent in patients with BMI >25 kg/m2 and weight gain ≥2 units |
| ARREST-AF165 | Prospective cohort study with control group | 149 (36 %) | Symptomatic AF scheduled for ablation; BMI ≥27 kg/m2 plus ≥1 other risk factor(s) | 42 (mean) | Structured weight management; aggressive risk-factor management versus information and risk-factor management by treating physician | Significant decrease in AF frequency, duration, symptoms and symptom severity versus controls; single-procedure AF-free survival off drugs markedly better than in controls |
| CARDIO-FIT167 | Prospective cohort study | 308 (51 %) | Symptomatic paroxysmal or persistent AF; BMI ≥27 kg/m2 | 49 (mean) | Risk-factor management and tailored exercise programme | AF-free survival greatest in patients with highest cardiorespiratory fitness; AF burden and symptom severity decreased significantly in patients with cardiorespiratory fitness gain ≥2 METs; AF-free survival greatest in patients with cardiorespiratory fitness gain ≥2 METs |
| RACE 326 | Prospective, randomised controlled trial | 245 (21 %) | Early persistent AF and mild-to-moderate HF | 12 | Conventional therapy (causal treatment of AF and HF and rhythm control therapy) versus conventional therapy plus medical therapy with MRAs, statins, ACE-Is and/or ARBs, and cardiac rehabilitation including physical activity, dietary restriction, and counselling | Significantly more patients in sinus rhythm at 1 year follow-up with targeted therapy of underlying conditions compared to conventional therapy; significantly more successful modification of blood pressure, NT-proBNP, weight, BMI and lipid profile with targeted therapy of underlying conditions compared to conventional therapy; AF symptoms decreased more with targeted therapy |
ACE-I = angiotensin-converting enzyme inhibitor; ARB = angiotensin II-receptor blocker; ARREST AF = Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation; CARDIO-FIT = CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation; HF = heart failure; LEGACY = Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study; METs = metabolic equivalents; MRA = mineralocorticoid receptor antagonist; NT-proBNP = N-terminal pro-brain natriuretic peptide; n/r = not reported; RACE 3 = Routine Versus Aggressive Upstream Rhythm Control for Prevention of Early Atrial Fibrillation in Heart Failure; WL = weight loss.