scholarly journals Feasibility of a Multidisciplinary Lifestyle Program for Obese Patients With Atrial Fibrillation

2020 ◽  
Author(s):  
Nicole Tenbult - van Limpt ◽  
JJ Kraal ◽  
RWM Brouwers ◽  
RF Spee ◽  
SCM Eijsbouts ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Physical Fitness ◽  
Behavioral Change ◽  
Dietary Advice ◽  
Obese Patients ◽  
Psychosocial Therapy ◽  
Lifestyle Program ◽  
Traditional Lifestyle ◽  
Secondary Endpoints

Abstract Aims: Atrial Fibrillation (AF) is often associated with obesity. The effects of traditional lifestyle programs are often not maintained in the longer term effects because the programs do not sufficiently focus on behavioral change. We want to study the feasibility of a multidisciplinary lifestyle program, cardiac rehabilitation (CR) focusing on behavioral change in patients with AF and obesity. Methods and results: Patients received CR for three months including exercise training, lifestyle counseling by an Advanced Nursing Specialist, dietary advice and psychosocial therapy when deemed necessary. Main endpoints were weight loss and burden of AF (AFSS questionnaire). Secondary endpoints were physical fitness (6MWT), depression (PHQ9) and anxiety (GAD7). Measurements were performed at baseline and post-CR. Weight and 6MWT were also assessed at 1-year follow-up. After following a lifestyle program, patients improved their weight and physical condition, and were less symptomatic. The frequency of AF-related symptoms was considerably reduced immediately after rehabilitation and was even lower after 1 year. The severity of AF complaints post-CR was similar to the baseline, but significantly lower after 1 year. Conclusion: A multidisciplinary lifestyle program with an emphasis on structural lifestyle improvement is feasible for obese patients with AF and potentially effective in reducing symptoms, weight and physical fitness, thereby decreasing the burden of AF.

Adherence and Feasibility of a Multidisciplinary Lifestyle program for Patients with Atrial Fibrillation and Obesity (Preprint)

2021 ◽  
Author(s):  
Nicole Tenbult ◽  
Jos Johannes Kraal ◽  
Rutger Brouwers ◽  
Rudolph Ferdinand Spee ◽  
Sabine Eijsbouts ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medical Research ◽  
Nurse Practitioner ◽  
Medical Center ◽  
Behavioural Change ◽  
Exploratory Analysis ◽  
Completion Rates ◽  
Psychosocial Therapy ◽  
Lifestyle Program ◽  
Lifestyle Counselling

BACKGROUND Atrial Fibrillation (AF) is commonly associated with obesity. Observational studies showed that weight loss and improvement of physical fitness are associated with improved prognosis and a decrease in AF symptoms. However, despite these benefits, non-adherence is common. OBJECTIVE In this study we evaluated the adherence and feasibility of a multidisciplinary lifestyle program focusing on behavioural change in patients with AF and obesity. METHODS Patients with AF and obesity received a goal-oriented CR program for three months including 4 fixed modules: lifestyle counselling by an Advanced Nurse Practitioner, exercise training, dietary consultation and psychosocial therapy; relaxation sessions were an additional optional treatment module. After this CR program the Advanced Nurse Practitioner monitored the personal lifestyle of each individual patient 3 and 9 months of discharge CR. The primary endpoints were compliance and completion rates of the CR program, the latter being defined as performing at least of 80 % of the prescribed sessions. In addition, we performed an exploratory analysis of effects on weight and AF burden and frequency. RESULTS Ten patients with AF and obesity were recruited. The majority of patients were male (8/2), the mean age was 57.2 ± 9.0 and the BMI 32.4 ± 3.5 kg / m2. Eight patients completed the 3-months CR program. Two patients did not complete their CR program, both because of private issues. Adherence to the fixed treatment modules was 95% for lifestyle counselling, 86% for physiotherapy sessions, 88% for dietician consultations and 60% received psychosocial therapy; concerning the optional additional modules, 70% of patients were referred to the relaxation sessions and the adherence was 86%. Both weight and physical condition were improved. Frequency of AF-related symptoms was considerably reduced immediately after rehabilitation and was even lower after 1 year. Severity of AF complaints post-CR was similar to the baseline, but significantly lower after 1 year. CONCLUSIONS A one-year multidisciplinary lifestyle program was feasible in obese patients with AF with high compliance and completion rates. An exploratory analysis revealed a sustained reduction in AF symptoms, however, these results remain to be confirmed in larger studies. CLINICALTRIAL The study protocol was submitted for approval to Medical Research Ethics Committee of Máxima Medical Center (Veldhoven, the Netherlands) which confirmed that the Dutch Medical Research Involving Human Subjects Act does not apply to this study and therefore waived formal approval.

scholarly journals The impact of catheter ablation for patients with asymptomatic atrial fibrillation: subanalysis of kansai plus atrial fibrillation (kpaf) registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Pak ◽  
A Kobori ◽  
S Shizuta ◽  
Y Sasaki ◽  
T Toyota ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Primary Endpoint ◽  
Hazard Analysis ◽  
Secondary Endpoint ◽  
Asymptomatic Patients ◽  
Significant Difference ◽  
Secondary Endpoints ◽  
The Impact

Abstract Background Catheter ablation (CA) of atrial fibrillation (AF) for symptomatic patients improves the quality of life and prognosis of patients with heart failure. However, the impact of CA for asymptomatic patients is still controversial. Purpose We aimed to investigate the clinical outcomes of CA of AF for asymptomatic patients compared to those for symptomatic patients. Methods A total of 5,013 patients from the Kansai Plus Atrial Fibrillation (KPAF) Registry who underwent CA were screened. The patients were divided into three groups by type of AF; paroxysmal (PAF), persistent (PEAF) and long standing (LSAF) and the patients in each type of AF were divided into two groups: asymptomatic and symptomatic. The primary endpoint was recurrent supraventricular tachyarrhythmias lasting for more than 30 seconds during follow-up 4 years after CA. The secondary endpoint was a composite of cardiovascular, cerebral, and gastrointestinal events during follow-up 4 years after CA. The incidence of complications related to CA between asymptomatic and symptomatic patients was also evaluated. Kaplan–Meier analysis was employed to estimate the primary and secondary endpoints. The statistical differences in primary and secondary endpoints between asymptomatic and symptomatic patients were evaluated using a log–rank test. The impact of symptom due to AF on the primary and secondary endpoint was evaluated using a Cox hazard analysis. The difference in incidence of complications between asymptomatic and symptomatic patients was evaluated using a chi–square test. Results In this study population, PAF was the most frequent at 64.4%, followed by PEAF (22.7%) and LSAF (13.0%). There were some significant differences in the baseline characteristics between asymptomatic and symptomatic patients in each type of AF. The proportion of male was significantly higher in asymptomatic patients than symptomatic patients in PAF (81.2% versus 67.2%, p<0.001) and PEAF (86.4% versus 74.3%, p<0.001). Left atrial diameter was larger in asymptomatic patients than symptomatic patients only in PAF (40±6mm versus 38±6mm, p<0.001). In all types of AF, there was no significant difference in primary endpoint between asymptomatic and symptomatic patients as follows: 37.5% versus 40.6% (p=0.6) in PAF, 45.2% versus 55.1% (p=0.09) in PEAF and 59.3% versus 63.6% (p=1.0) in LSAF. There was also no significant difference in secondary endpoint between asymptomatic and symptomatic patients: 7.1% versus 6.8% (p=0.7) in PAF, 5.4% versus 8.7% (p=0.3) in PEAF and 4.4% versus 5.1% (p=0.5) in LSAF. In a Cox hazard analysis, the symptom did not affect both of the primary and secondary endpoints in each type of AF. In regard to the incidence of complications related to CA, there was no significant difference between asymptomatic and symptomatic patients in each type of AF. Conclusion CA of AF for asymptomatic patients can be safe and can lead to equivalent outcomes as well as symptomatic patients. Funding Acknowledgement Type of funding source: None

scholarly journals Association between pre-ablation bariatric surgery and atrial fibrillation recurrence in morbidly obese patients undergoing atrial fibrillation ablation

EP Europace ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. 1476-1483 ◽  
Author(s):  
Eoin Donnellan ◽  
Oussama M Wazni ◽  
Mohamed Kanj ◽  
Bryan Baranowski ◽  
Paul Cremer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Bariatric Surgery ◽  
Propensity Score ◽  
Multivariable Analysis ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Af Ablation ◽  
The Impact ◽  
Af Recurrence

Abstract Aims Obesity decreases arrhythmia-free survival after atrial fibrillation (AF) ablation by mechanisms that are not fully understood. We investigated the impact of pre-ablation bariatric surgery (BS) on AF recurrence after ablation. Methods and results In this retrospective observational cohort study, 239 consecutive morbidly obese patients (body mass index ≥40 kg/m2 or ≥35 kg/m2 with obesity-related complications) were followed for a mean of 22 months prior to ablation. Of these patients, 51 had BS prior to ablation, and our primary outcome was whether BS was associated with a lower rate of AF recurrence during follow-up. Adjustment for confounding was performed with multivariable Cox proportional hazard models and propensity-score based analyses. During a mean follow-up of 36 months after ablation, 10/51 patients (20%) in the BS group had recurrent AF compared with 114/188 (61%) in the non-BS group (P < 0.0001). In the BS group, 6 patients (12%) underwent repeat ablation compared with 77 patients (41%) in the non-BS group, (P < 0.0001). On multivariable analysis, the association between BS and lower AF recurrence remained significant. Similarly, after weighting and adjusting for the inverse probability of the propensity score, BS was still associated with a lower hazard of AF recurrence (hazard ratio 0.14, 95% confidence interval 0.05–0.39; P = 0.002). Conclusion Bariatric surgery is associated with a lower AF recurrence after ablation. Morbidly obese patients should be considered for BS prior to AF ablation, though prospective multicentre studies should be performed to confirm our novel finding.

scholarly journals Cryoballoon Versus Laserballoon: Insights from the First Prospective Randomized Balloon Trial in Catheter Ablation of Atrial Fibrillation

2021 ◽  
Author(s):  
Julian K.R. Chun ◽  
Stefano Bordignon ◽  
Jana Last ◽  
Lukas Mayer ◽  
Shota Tohoku ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antiarrhythmic Drugs ◽  
Fluoroscopy Time ◽  
Office Visits ◽  
Phrenic Nerve Palsy ◽  
Procedural Complications ◽  
Secondary Endpoints ◽  
To Receive ◽  
Laser Balloon

Background - Pulmonary vein isolation (PVI) represents the cornerstone in atrial fibrillation ablation. Cryoballoon (CB) and laser balloon (LB) catheters have emerged as promising devices but lack randomized comparisons. Therefore, we sought to compare efficacy and safety comparing both balloons in patients with persistent and paroxysmal AF. Methods - Symptomatic AF patients (n=200) were prospectively randomized (1:1) to receive either CB or LB PVI (CB: n=100: 50 PAF + 50 persistent AF vs. LB: n=100: 50 PAF + 50 persistent AF). All antiarrhythmic drugs (AAD) were stopped after ablation. Follow-up included 3-day Holter-ECG recordings and office visits at 3, 6 and 12 months. Primary efficacy endpoint was defined as freedom from atrial tachyarrythmia (ATa) between 90 and 365 days after a single ablation. Secondary endpoints included procedural parameters and peri-procedural complications. Results - Patient baseline parameters were not different between both groups. In all (n=200) complete PVI was obtained and the entire follow-up accomplished. Balloon only PVI was obtained in 98% (CB) vs. 95% (LB) requiring focal touch up in 2 and 5 patients, respectively. Procedure but not fluoroscopy time was significantly shorter in the CB group (50.9±21.0min vs. 96.0±20.4 min; p<0.0001 and 7.4±4.4 min vs. 8.4±3.2min, p=0.083). Overall, the primary endpoint of no ATa reccurence was met in 79% (CB: 80.0% vs LB: 78.0%, p=ns). No death, atrio-esophageal fistula, tamponade or vascular laceration requiring surgery occurred. In the CB group, 8 transient but no persistent phrenic nerve palsy (PNP) were noted compared to 2 persistent PNP and 1 TIA in the LB group. Conclusions - Both balloon technologies represent highly effective and safe tools for PVI resulting in similar favorable rhythm outcome after 12 months. Use of the cryoballoon is associated with significantly shorter procedure but not fluoroscopy time.

scholarly journals One-Year Effectiveness of a 3-Week Balneotherapy Program for the Treatment of Overweight or Obesity

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Thierry Hanh ◽  
Patrick Serog ◽  
Jérôme Fauconnier ◽  
Pierre Batailler ◽  
Florence Mercier ◽  
...  
Keyword(s):  
Motivational Interview ◽  
Protocol Analysis ◽  
Controlled Trial ◽  
Dietary Advice ◽  
Obese Patients ◽  
One Year ◽  
The One ◽  
Randomised Controlled ◽  
Overweight Or Obesity

Objective. To assess the one-year effectiveness on weight loss of a 3-week balneotherapy program (BT).Method. A Zelen double consent randomised controlled trial to compare one-year BMI loss between a 3-week BT program versus usual care (UC) for overweight or obese patients (BMI: 27–35 kg/m2), associated or not with a dietary motivational interview (DMI) during the follow-up, using a 2 × 2 factorial design. Main analysis was a per protocol analysis comparing patients attending BT to patients managed by UC, matched on sex, overweight or obese status, DMI randomisation and a propensity score to attend BT or to be managed by UC.Results. From the 257 patients who completed the follow-up, 70 patients of each group could be matched. Mean BMI loss was 1.91 kg/m2[95%CI: 1.46; 2.35] for the BT patients and 0.20 kg/m2[−0.24; 0.64] for the UC patients (P<0.001), corresponding to a significant BT benefit of 1.71 kg/m2[1.08; 2.33]. There was no significant effect of DMI and no interaction with BT or UC. No adverse reaction was observed for patients attending BT.Conclusion. A 3-week BT program provided a significant one-year benefit over the usual GP dietary advice for overweight and obese patients.

scholarly journals Clinical and Pathogenetic Assessment of Relationships Between the Dynamics of Body Weight Changes and Atrial Fibrillation in Patients with Primary Obesity

2021 ◽  
Vol 11 (5) ◽  
pp. 389-400
Author(s):  
E. A. Praskurnichiy ◽  
O. I. Morozova
Keyword(s):  
Atrial Fibrillation ◽  
Body Weight ◽  
Clinical Course ◽  
Persistent Atrial Fibrillation ◽  
Obese Patients ◽  
Initial Body Weight ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aims. To evaluate the impact of body weight dynamics on the clinical course of atrial fibrillation in obese patients.Materials and methods. The study included 101 primary obese patients with paroxysmal or persistent atrial fibrillation. Study design: a retrospective, single-center, comparative study. Retrospectively аccording to the he body weight dynamics, patients were divided into 3 groups: those who increased their body weight by >3 % (Group 1, n=40), maintained their initial body weight by ±2.9 % (Group 2, n=29), and reduced their initial body weight by >3 % (Group 3, n=32). Follow-up examinations by a doctor were carried out at least once every 6 months for minimum 36 months. Change in AF type was determined by disease patterns and 7-day Holter monitoring results. The groups were comparable in gender (p=0,9267), age (p=0,3841), height (p=0,8900), and disease form (Paroxysmal atrial fibrillation /Persistent atrial fibrillation) (p=0,8826), the severity of symptoms on the European Heart Rhythm Association score of atrial fibrillations (p=0,8687) and systolic blood pressure at the beginning of the study (p=0,4500).Results. At the final control examination, the body weight of patients in Group 1 increased by an average of 11,4 [9,3; 13,1] kg (р <0,001*), while weight loss in Group 3 averaged -6,2 [-8,4; -5,3] kg (p <0,001*). The decrease in body weight of Group 2 patients was insignificant (p=0,5377) and amounted to -0,1 [-2,0; 1,3] kg. The progression of the disease from paroxysmal to persistent form was observed among 15 (37 %) patients in Group 1, 9 (31 %) patients — in Group 2, 2 (6 %) patients — in Group 3 (p=0,0079*). The regression of arrhythmia from persistent to paroxysmal form was not registered in group 1 (0 %), in group 2, the reverse development of the disease was noted in 1 patient (3 %) and in group 3 — in 6 patients (19 %) (p=0,0053*). There were no free from AF patients in Group 1 at the final follow-up, while 2 (7 %) patients were free from AF in Group 2 and 7 (22 %) — in Group 3 (р=0,0047*). In patients undergoing ablation, procedural success was determined after a 3-month blind period. The need for interventional procedures to restore the sinus rhythm and their multiplicity when comparing the groups did not differ significantly. However, in a pairwise comparison, the difference between groups 1 and 3 of participants was statistically significant (p=0,0079* and p=0,0374*, respectively). Conclusion. This study demonstrates the relationships between the dynamics of body weight and the clinical course of atrial fibrillation. The progression of obesity leads to the progression of the disease. Weight-loss management reverses the type and natural progression of AF, improves the prognosis and the course of disease, regardless of other significant risk factors, increases the anti-arrhythmic therapy effect and the effect of interventional treatment.

P963Recurrence of atrial fibrillation after cryoballoon pulmonary vein isolation in overweight and obese patients - does weight matter?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Weinmann ◽  
S Gillmeister ◽  
D Aktolga ◽  
C Bothner ◽  
M Rattka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Obese Patients ◽  
Baseline Characteristics ◽  
One Year ◽  
Af Recurrence

Abstract Funding Acknowledgements Karolina Weinmann was supported by the Hertha-Nathorff fellowship from Ulm University Background - Obesity is a known risk factor for the incidence and persistence of atrial fibrillation. Many interventional studies proved losing weight correlates with less atrial fibrillation (AF) burden. Purpose – We investigated the influence of overweight and obesity on baseline characteristics, procedural values and outcome after cryoballoon pulmonary vein isolation (cryoballoon PVI). Methods – We investigated 575 patients undergoing cryoballoon PVI at our Medical Center. 142 patients were classified as normal with a body mass index (BMI) of 18.5 – 24.9 kg/m², 239 patients presented overweight with a BMI of 25.0 – 29.9 kg/m² and 194 patients were obese with a BMI over 30.0. We compared the baseline characteristics, the procedural and outcome data of these patients. Results – Comparing baseline characteristics of overweight and obese patients to normal weight patients, obese show the highest portion in hypertension (obese vs. normal: 86.1% vs. 68.3%, p &lt; 0.001), diabetes (26.8% vs. 14.8%, p &lt; 0.05), OSAS (17.0% vs. 2.1%, p &lt; 0.001) and left atrial (LA) diameter (44.6 ± 10.8mm vs. 41.3 ± 12.7mm, p &lt; 0.05). Comparison of procedure duration, fluoroscopy time and area dose product (Gy*cm²), only the area dose product shows a significantly higher value in the overweight and obese patients (p &lt; 0.001). Moreover, comparing the duration of ablation, time to isolation per pulmonary vein between the three groups, the overweight and obese patients show a significantly longer duration of ablation at the RSPV and the time to isolation is significantly higher at the LSPV. Mean follow-up period in our cohort is 517.3 ± 461.3 days (1.4 ± 1.3 years). Kaplan-Meier estimation shows no significant difference between freedom from AT/AF recurrence comparing normal weight, overweight and obese patients (Log-rank p = 0.6). After one year follow-up, 70% of normal weight patients show freedom from atrial arrhythmia recurrence and 69% of overweight patients.  Obese patients have a fraction of 75% of freedom from AT/AF recurrence after one year. Comparing the two years follow-up values 56% of the normal BMI patients, 54% of the overweight patients and 62% of obese patients are free from arrhythmia recurrence. Conclusion – Cryoballoon PVI procedure in obese and overweight patients is a feasible treatment, however the radiation exposure is higher compared to normal weight. Evaluating outcomes, no difference in recurrence of AF was detected between normal, overweight and obese patients after cryoballoon PVI.

Abstract 15459: Impact of Progression From Paroxysmal to Sustained Atrial Fibrillation on Clinical Outcomes in Patients With Obesity: The Fushimi Af Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Akiko Fujino ◽  
Hisashi Ogawa ◽  
Kenjiro Ishigami ◽  
Syuhei Ikeda ◽  
KOSUKE DOI ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Arterial Remodeling ◽  
Obese Patients ◽  
Increased Risk ◽  
Rate Of Progression ◽  
Risk Of Progression ◽  
Incidence Of Hospitalization

Background: Obesity, which leads to left arterial remodeling, increases the risk for the development of atrial fibrillation (AF). We previously demonstrated the progression from paroxysmal to sustained AF was associated with an increased risk of ischemic stroke or hospitalization for heart failure (HF). However, the risk of progression from paroxysmal to sustained AF in obese patients has not been fully evaluated. Methods: Based on the initial type of AF and whether paroxysmal AF progressed to sustained AF during follow-up (FU), patients enrolled in the Fushimi AF registry were categorized into 3 groups; i) paroxysmal AF without progression, ii) paroxysmal AF with progression, iii) sustained AF. Obesity was defined as BMI at baseline >30. Results: Obese patients (172/3834) had a higher prevalence of sustained AF at baseline as compared with those without obesity (58.7% vs 51.0%, p=0.047), and they had a higher rate of progression from paroxysmal to sustained AF during a median FU of 4.3 years (2.4% vs 1.5% [per person-year], p<0.01). Both obese and non-obese patients had the highest rate of ischemic stroke in the category of paroxysmal AF with progression as compared with other two categories (obese patients: 0.2% [paroxysmal AF without progression] vs 2.6% [paroxysmal AF with progression] vs 0.7% [sustained AF] [per person-year], non-obese patients: 1.2% vs 2.2% vs 1.8%). In contrast, obese patients had the lowest percentage of hospitalization for HF in the category of paroxysmal AF with progression (2.5% vs 1.8% vs 3.8%), but AF progression was associated with a higher incidence of hospitalization for HF in patients without obesity (2.2% vs 3.9% vs 4.2%). Conclusions: Obesity may be the risk of the progression of paroxysmal to sustained AF. The progression may be associated with increased risk of ischemic stroke in both obese and non-obese patients, but the risk of hospitalization for HF might be lower in patients with obesity as compared with those without obesity.

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