LEAF: Weight loss before procedure confers better atrial fibrillation ablation outcomes
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Key takeaways:
- Patients with atrial fibrillation who lost at least 3% of body weight before catheter ablation were more likely to not have AF at 6 months.
- The results highlight the benefits of weight loss in patients with AF.
Among patients with atrial fibrillation who chose to undergo catheter ablation, those who lost at least 3% of body weight before the procedure were more likely to be free from AF at 6 months, according to early results of the LEAF trial.
For the LEAF trial, whose interim results were presented at Heart Rhythm 2023, Jeffrey Goldberger, MD, MBA, director of the Center for Atrial Fibrillation and professor of medicine and biomedical engineering at UHealth – the University of Miami Health System and the Miami Miller School of Medicine, and colleagues enrolled 65 patients with BMI 27 kg/m2 or more who had persistent or paroxysmal AF and chose to undergo catheter ablation.
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All patients underwent a 3-month pre-ablation period and were randomly assigned to standard risk factor modification alone or standard risk factor modification plus liraglutide (Saxenda, Novo Nordisk).
“Weight is a very important risk factor for atrial fibrillation and also affects outcomes. Our colleagues in Australia have done a number of important studies showing the effect of weight on outcomes for atrial fibrillation ablation. In 2019, risk factor modification and weight loss were therefore included as a class I recommendation for obese and overweight patients with atrial fibrillation,” Goldberger said during a press conference. “We also know that epicardial adipose tissue ... is also a risk factor for atrial fibrillation and has been associated with outcomes after atrial fibrillation. A colleague, Gianluca Iacobellis, MD, PhD, had done some studies looking at the effect of liraglutide, which is a GLP-1 agonist, showing both weight loss but substantial reduction in epicardial fat.”
The study was designed to determine whether, given its effects on weight and epicardial fat, liraglutide taken before catheter ablation would improve outcomes, he said.
Of the 59 patients who did not withdraw before ablation, the mean age was 62 years, 27% were women, the mean weight was 106.4 kg, the mean BMI was 36.1 kg/m2 and 79% had persistent AF. For the present interim analysis, patients were stratified by whether they lost less than 3% of body weight (group 1) or 3% to 10% of body weight (group 2) between enrollment and time of ablation (at least 3 months).
At 6 months after ablation, group 1 had a mean weight gain of 0.2% and group 2 had a mean weight loss of 5.6%, Goldberger and colleagues found.
The rate of freedom from AF off antiarrhythmic drugs at 6 months was 61% in group 1 and 88% in group 2 (Fisher test P = .046; ordinal logistic regression [OLR] P = .031), according to the researchers.
In patients with persistent AF, including one whose AF was resolved by weight loss and did not need to undergo catheter ablation, the rate of freedom from AF off antiarrhythmic drugs at 6 months was 61% in group 1 and 90% in group 2 (Fisher test P = .058; OLR P = .051) and at 12 months was 42% in group 1 and 81% in group 2 (Fisher test P = .05; OLR P = .038), Goldberger and colleagues found.
“This was a dramatic increase in the success of pulmonary vein isolation in those who lost weight,” Goldberger said during the press conference.
The effect of liraglutide on the results has not yet been analyzed, but data on that issue are expected to be presented in the upcoming months, Goldberger said during the press conference.
“A rhetorical question we should all ask ourselves is when we look at a patient with atrial fibrillation, how do we relate to the disease?” Goldberger said during the press conference. “Do we think of atrial fibrillation as a disease like Wolff-Parkinson-White syndrome, where a patient has their ablation, and if it is successful, we expect it to last in perpetuity with no further interventions, or is it more like coronary artery disease, where even if the patient has an intervention, the disease process is ongoing and requires long-term management? I think it’s pretty clear that we are dealing with the latter case. Hopefully, we can refocus on trying to come up with the best novel adjunctive therapies to use in conjunction with catheter ablation to improve outcomes.”
Perspective
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Fred Kusumoto, MD, FHRS
Preprocedure weight loss (and likely optimizing other modifiable risk factors) had a meaningful impact on ablation success. The study confirms the importance of a holistic approach to AF, and it is remarkable that after a relatively short period (3 months) in preparation for an AF ablation, 50% of patients lost 3% or more of weight.
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Goldberger J, et al. Late-Breaking Clinical Trials and Science – Ablation. Presented at: Heart Rhythm 2023; May 19-21, 2023; New Orleans (hybrid meeting).
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