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Journal Club 2 December 2015


Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort





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. 


This study sought to evaluate the long-term impact of weight loss and weight fluctuation on rhythm control in obese individuals with AF.


Of 1,415 consecutive patients with AF, 825 had a body mass index $27 kg/m2 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.


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 5% partially offset this benefit, with a 2-fold (95% confidence interval: 1.0 to 4.3; p ¼ 0.02) increased risk of arrhythmia recurrence.


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]

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