Feasibility of weight loss in obese atrial fibrillation patients attending a specialist arrhythmia clinic and its impact on ablation outcomes

Background: The feasibility of significant weight reduction in a specialist arrhythmia service, and its impact on atrial fibrillation (AF) ablation outcomes are unclear. We aimed to assess these factors in a real-world cohort in the United Kingdom. Methods: Patients from one specialized arrhythmia clinic were instructed to follow the Intermittent Fasting 5:2 diet (diet group, n = 50), and their outcomes were compared to a propensity matched cohort who received no specific dietary advice (control group, n = 42). The primary outcome was recurrence of AF or atrial tachycardia (AT) at 12 months postablation, with or without drugs. Results: Body weight and body mass index (BMI) at baseline were 105.0 (+/- 15.3) kgs and 36.0 (+/- 4.0), respectively. Baseline characteristics between the two groups were comparable. Patients in diet group experienced a mean weight loss of 8.2 (+/- 7.1) kgs prior to AF ablation (P < .01 for comparison to baseline and control group). About 14 (28%) patients in the diet group lost >10% of their body weight. Overall, 11 (22%) patients in the diet group and five (12%) in the control group had AF recurrence at 1 year,P = .21. AF recurrence was similar in patients with BMI >= 35 (15%) as compared to BMI < 35 (19%),P = .60. There was one procedural complication (pulmonary edema) in the diet group. Conclusion: It is feasible to achieve significant weight reduction in obese AF patients in a specialist arrhythmia clinic setting with unsupervised dietary advice. Low rates of procedural complications and excellent medium-term success rates were observed in this traditionally challenging population. Additional improvements in outcomes were not demonstrable in patients who exhibited significant weight loss.