Abstract
The rising burden of atrial fibrillation (AF) has led to increasing hospitalizations and health care expenditure in developed nations. 1 Gallagher C. Hendriks J.M. Giles L. et al. Increasing trends in hospitalisations due to atrial fibrillation in Australia from 1993 to 2013. Heart. 2019; 105: 1358-1363 Crossref PubMed Scopus (26) Google Scholar Urgent strategies are needed both to prevent disease onset and to improve outcomes in patients with established AF. The role of modifiable and lifestyle risk factors, such as hypertension, obesity, diabetes, obstructive sleep apnea (OSA), alcohol consumption, and physical inactivity, in AF pathogenesis is well recognized. 2 Lau D.H. Nattel S. Kalman J.M. Sanders P. Modifiable risk factors and atrial fibrillation. Circulation. 2017; 136: 583-596 Crossref PubMed Scopus (231) Google Scholar Numerous epidemiologic studies have demonstrated a strong and graded association between excessive body weight and risk of AF whereby every 5-unit increment in body mass index (BMI) was found to confer an additional 19%–29% risk of incident AF. 3 Lavie C.J. Pandey A. Lau D.H. Alpert M.A. Sanders P. Obesity and atrial fibrillation prevalence, pathogenesis, and prognosis: effects of weight loss and exercise. J Am Coll Cardiol. 2017; 70: 2022-2035 Crossref PubMed Scopus (150) Google Scholar ,4 Wong C.X. Sullivan T. Sun M.T. et al. Obesity and the risk of incident, post-operative, and post-ablation atrial fibrillation: a meta-analysis of 626,603 individuals in 51 studies. JACC Clin Electrophysiol. 2015; 1: 139-152 Crossref PubMed Scopus (115) Google Scholar However, the association between bodyweight variability and AF risk remains less well defined. Recent work suggests that increased AF risk due to BMI variability was more pronounced in the context of net weight gain than weight loss over time. 5 Lim Y.M. Yang P.S. Jang E. et al. Body mass index variability and long-term risk of new-onset atrial fibrillation in the general population: a Korean nationwide cohort study. Mayo Clin Proc. 2019; 94: 225-235 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Furthermore, in the context of risk factor modification and intentional weight loss in patients with AF, our group has demonstrated that weight fluctuation resulted in lower freedom from AF than linear weight loss, and there seems to be a dose effect whereby greater weight fluctuation (>5%) conferred significantly lower freedom from AF. 6 Pathak R.K. Middeldorp M.E. Meredith M. et al. Long-term effect of goal-directed weight management in an atrial fibrillation cohort: a long-term follow-up study (LEGACY). J Am Coll Cardiol. 2015; 65: 2159-2169 Crossref PubMed Scopus (462) Google Scholar It is in this context that the study by Lee et al 7 Lee H.-J. Choi E.-K. Han K.-D. et al. Bodyweight fluctuation is associated with increased risk of incident atrial fibrillation. Heart Rhythm. 2020; 17: 365-371 Abstract Full Text Full Text PDF Scopus (11) Google Scholar in this issue of Heart Rhythm Journal is a welcome addition to the field. Bodyweight fluctuation is associated with increased risk of incident atrial fibrillationHeart RhythmVol. 17Issue 3PreviewObesity and weight gain are established risk factors for atrial fibrillation (AF). Full-Text PDF
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