Abstract 15427: Reduction of Epicardial Fat, Clinical Risk Factors & Symptomatology in Paroxysmal AF Patient With Severe Aortic Stenosis and Metabolic Syndrome via Mobile Cardiometabolic Health & Weight Loss Program

Abstract

Atrial fibrillation (AF) is dependent on epicardial fat (EpF) accumulation and infiltration. Complementary therapeutic strategies specifically targeting EpF present an opportunity for slowing progression and reversing the course of AF. A 73-year-old man with a history paroxysmal AF (managed by rate control/anticoagulation), severe aortic valve stenosis (AVS, area 1cm 2 , EF 55%), controlled hypertension, diabetes, and obesity (BMI 37.9) completed a 2-month cardiometabolic health program (CHP). The ‘tech plus touch’ CHP, delivered via a smartphone, utilized a comprehensive approach with physiological, nutritional, and behavioral components. Along with patented dietary regimens and nutritional supplementation implemented with personalized treatment algorithms, the CHP included direct daily engagement (messaging & telehealth) with a staff clinician via the HIPAA compliant mobile app. Patient data visible to both the patient and staff clinician was synced automatically via Bluetooth-linked devices. EpF dropped by 25.5% over 9w (transthoracic echo, Fig1). BMI, visceral adiposity, and body fat were significant reduced, while lean body mass (LBM), muscle mass (MM) and intracellular fluid (ICF, a validated surrogate of chronic inflammation) improved (Fig1). Encouragingly, LBM, MM, and ICF improvements were unusual and particularly large in this older, physically inactive patient. Other clinical risk factors improved including diabetes, kidney function and inflammation. The patient reported resolution of chest pain and dyspnea, improved cardiorespiratory fitness, and began aerobic exercise. Our data demonstrate a nonpharmacologic complementary approach produces significant reductions of EpF and modifiable risk factors linked to hypertension, diabetes, and chronic inflammation in an AF patient with AVS and metabolic syndrome. Whether this will lead to a reduction in AF burden or conversion to persistent AF, remains to be determined.