Key Points
- Observation data has suggested that improving cardiometabolic risk factors after AF ablation may reduce the recurrence of arrythmias.
- The ARREST-AF trial provides randomized controlled evidence demonstrating the benefits of a physician-led clinic focusing on risk factor modification (RFM) in reducing arrhythmia recurrence at 12 months.
- Patients in the RFM group were significantly more likely to be free from recurrent arrhythmia and experienced improved AF symptom scores compared to those receiving usual care.
- Improvements in body weight, systolic blood pressure, glycemic control, and exercise capacity were also observed in the RFM group, underscoring the role of risk factor control in mediating the observed benefits.
Prior observational studies have pointed to the role of aggressive risk factor modification (RFM) in improving long-term outcomes after catheter ablation for atrial fibrillation (AF). However, randomized controlled trial data to validate this hypothesis has been lacking.
On November 18th 2024, the results of “Aggressive Risk factor REduction STudy for Atrial Fibrillation (ARREST-AF) implications for ablation outcomes: A Randomized Clinical Trial” were presented at AHA Scientific Sessions 2024. The purpose of this study was to determine if attempts at intensive RFM after AF ablation improves outcomes.
This randomized controlled trial included 122 consecutive Australian adult patients with paroxysmal or persistent symptomatic AF undergoing catheter ablation (pulmonary vein isolation with additional ablation at operator discretion) who had a body mass index of ≥ 27 kg/m2 and one additional cardiometabolic risk factor. Patients with severe structural heart or systemic disease were excluded. They were assigned in a 1:1 fashion at to RFM or usual care arm. Patients in the RFM arm received intensive risk factor management through a physician-led clinic, following AHA guideline-based recommendations. Patients in the usual care arm received standard, guideline-directed care for AF management. The primary endpoint was proportion of patients free from AF recurrence 12 months post-ablation. Secondary endpoints included changes in AF symptom severity, cardiometabolic risk factors, exercise capacity and need for redo ablation.
At 12 months, 66% of patients in the RFM group were free from AF recurrence at 12 months, compared to 42% in the usual care group, a significant difference (HR 2.18 [95% CI 1.25-3.70]; p=0.004). In addition, AF symptom severity was significantly improved in the RFM group compared to the usual care group. The RFM group also had significantly improved body weight, glycemic control, and exercise capacity, indicating that the intervention was successful at achieving an improvement in control of major cardiometabolic risk factors.
Rajeev K. Pathak, MD, PhD, FACC, Director of Cardiac Electrophysiology at Canberra Heart Rhythm in Garran, Australia, concluded: “Amongst patients with AF, elevated BMI and one additional cardiometabolic risk factor, aggressive risk factor management reduces arrhythmia recurrence in the 12-months following catheter ablation when compared with usual care.”