Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study

J Am Coll Cardiol. 2014 Dec 2;64(21):2222-31. doi: 10.1016/j.jacc.2014.09.028. Epub 2014 Nov 24.


Background: The long-term outcome of atrial fibrillation (AF) ablation demonstrates attrition. This outcome may be due to failure to attenuate the progressive substrate promoted by cardiovascular risk factors.

Objectives: The goal of this study was to evaluate the impact of risk factor and weight management on AF ablation outcomes.

Methods: Of 281 consecutive patients undergoing AF ablation, 149 with a body mass index ≥27 kg/m(2) and ≥1 cardiac risk factor were offered risk factor management (RFM) according to American Heart Association/American College of Cardiology guidelines. After AF ablation, all 61 patients who opted for RFM and 88 control subjects were assessed every 3 to 6 months by clinic review and 7-day Holter monitoring. Changes in the Atrial Fibrillation Severity Scale scores were determined.

Results: There were no differences in baseline characteristics, number of procedures, or follow-up duration between the groups (p = NS). RFM resulted in greater reductions in weight (p = 0.002) and blood pressure (p = 0.006), and better glycemic control (p = 0.001) and lipid profiles (p = 0.01). At follow-up, AF frequency, duration, symptoms, and symptom severity decreased more in the RFM group compared with the control group (all p < 0.001). Single-procedure drug-unassisted arrhythmia-free survival was greater in RFM patients compared with control subjects (p < 0.001). Multiple-procedure arrhythmia-free survival was markedly better in RFM patients compared with control subjects (p < 0.001), with 16% and 42.4%, respectively, using antiarrhythmic drugs (p = 0.004). On multivariate analysis, type of AF (p < 0.001) and RFM (hazard ratio 4.8 [95% confidence interval: 2.04 to 11.4]; p < 0.001) were independent predictors of arrhythmia-free survival.

Conclusions: Aggressive RFM improved the long-term success of AF ablation. This study underscores the importance of therapy directed at the primary promoters of the AF substrate to facilitate rhythm control strategies.

Keywords: cardiac risk factors; catheter ablation; follow-up studies; obesity; outcomes remodeling.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alcohol Drinking
  • Atrial Fibrillation / etiology
  • Atrial Fibrillation / prevention & control*
  • Atrial Fibrillation / surgery*
  • Blood Glucose / analysis
  • Blood Pressure
  • Body Mass Index
  • Case-Control Studies
  • Catheter Ablation*
  • Cohort Studies
  • Dyslipidemias / blood
  • Dyslipidemias / drug therapy
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin / analysis
  • Humans
  • Life Style
  • Lipids / blood
  • Male
  • Middle Aged
  • Recurrence
  • Risk Factors
  • Severity of Illness Index
  • Sleep Apnea, Obstructive / diagnosis
  • Sleep Apnea, Obstructive / therapy
  • Smoking Cessation
  • Weight Reduction Programs


  • Blood Glucose
  • Glycated Hemoglobin A
  • Lipids
  • hemoglobin A1c protein, human