Abstract 13752: Impact of Pre-ablation Weight Changes on Freedom From Atrial Fibrillation

Abstract

Introduction: Obesity is an established risk factor for recurrent atrial fibrillation (AF) after ablation. The impact of pre-procedure weight changes on freedom from AF (FFAF) post-ablation in both obese and non-obese patients is unknown. Hypothesis: Weight gain over the year prior to AF ablation is associated with reduced FFAF. Methods: A single-center retrospective cohort study of patients undergoing AF ablation using cryoballoon (CBA) was performed. Prior to ablation, all candidates were encouraged to adopt healthy lifestyle habits according to AHA guidelines, including weight loss, by their treating physician. Inclusion criteria included availability of weight measurements 1-year prior to and at the time of CBA, and post-CBA follow up > 90 days. The primary endpoint was FFAF through 1-year after the 3-month blanking period. Results: Among 747 CBA performed from 2011-2017, 720 patients (49% male; average age 61.3 ± 10.3 years) met inclusion criteria. Of these, 241 patients (33.5%) were obese (body mass index ≥ 30) and 337 (46.8%) had non-paroxysmal AF. There were 9.5 ± 2.8 freezes per patient and 99 patients had additional ablation lesion sets delivered. Overall, FFAF was observed in 506 (70.3%) patients at 15 months. Multivariate analysis revealed that weight loss (p<0.001), paroxysmal AF (p=0.036), shorter duration of AF diagnosis (p=0.022) and absence of AF during the 90-day blanking period (p<0.001) were associated with FFAF. Kaplan-Meier estimates of FFAF by pre-ablation weight changes in obese and non-obese patients are shown in Figure 1a-b. In obese and non-obese patients, weight loss was associated with FFAF in a dose- dependent and binary manner, respectively. Conclusions: Weight gain in the year prior to AF ablation was associated with lower rates of FFAF regardless of baseline BMI. Patient directed weight loss should be encouraged prior to AF ablation.