Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study

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dc.contributor.author Pathak, Rajeev K
dc.contributor.author Middeldorp, Melissa E
dc.contributor.author Lau, Dennis H
dc.contributor.author Mehta, Abhinav B
dc.contributor.author Mahajan, Rajiv
dc.contributor.author Twomey, Darragh J
dc.contributor.author Alasady, Muayad
dc.contributor.author Hanley, Lorraine
dc.contributor.author Antic, Nicholas Alexander
dc.contributor.author McEvoy, Ronald Douglas
dc.contributor.author Kalman, Jonathan M
dc.contributor.author Abhayaratna, Walter P
dc.contributor.author Sanders, Prashanthan
dc.date.accessioned 2016-02-24T22:03:26Z
dc.date.available 2016-02-24T22:03:26Z
dc.date.issued 2014-12-02
dc.description Version of record (Published version) freely available online at Publisher website <http://dx.doi.org/10.1016/j.jacc.2014.09.028> en
dc.description.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. OBJECTIVES: 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. en
dc.identifier.citation Pathak, R.K., Middeldorp, M., Lau, D.H., Mehta, A., Mahajan, R., Twomey, D., et al. (2014). Aggressive Risk factor Reduction Study for Atrial Fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. Journal of The American College of Cardiology, 64(21) pp. 2222-2231. en
dc.identifier.doi https://doi.org/10.1016/j.jacc.2014.09.028 en
dc.identifier.issn 0735-1097
dc.identifier.uri http://dx.doi.org/10.1016/j.jacc.2014.09.028
dc.identifier.uri http://hdl.handle.net/2328/35983
dc.language.iso en en
dc.publisher Elsevier en
dc.relation http://purl.org/au-research/grants/NHMRC/627227 en
dc.relation.grantnumber NHMRC/627227 en
dc.rights Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. en
dc.rights.holder American College of Cardiology Foundation en
dc.title Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study en
dc.type Article en
local.contributor.authorOrcidLookup McEvoy, Ronald Douglas: https://orcid.org/0000-0002-5759-0094 en_US
local.contributor.authorOrcidLookup Sanders, Prashanthan: https://orcid.org/0000-0003-3803-8429
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