Dr. Prashanthan Sanders, a leader in atrial fibrillation prevention, and Dr. Mehak Dhande, an electrophysiologist focusing on lifestyle changes, discuss the groundbreaking ARREST-AF trial. They reveal how an intensive risk factor management program significantly improved outcomes for atrial fibrillation patients. Topics include successful lifestyle modifications like weight loss and better management of health conditions, along with strategies to enhance patient education and access to care. Their insights emphasize the need for tailored approaches in cardiovascular health.
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volunteer_activism ADVICE
AFib Management
Prioritize rate control for symptomatic relief in AFib patients.
Then consider rhythm control and always address anticoagulation needs.
insights INSIGHT
Combined Treatment
Lifestyle changes aren't separate from other treatments, but boost them.
Prior studies already hinted at this before ARREST-AF's randomized data.
volunteer_activism ADVICE
Concurrent Management
Offer rhythm control and lifestyle changes concurrently for AFib.
Don't treat lifestyle and ablation as sequential steps.
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Join CardioNerds EP Council Chair Dr. Naima Maqsood and Episode Lead Dr. Jeanne De Lavallaz as they discuss the results of the ARREST-AF Trial with expert faculty Dr. Prashanthan Sanders and Dr. Mehak Dhande. Audio editing by CardioNerds intern Bhavya Shah.
The ARREST-AF trial enrolled 122 patients with a BMI of 27 kg/m2 or greater and at least one cardiovascular risk factor with either paroxysmal or persistent AF and were scheduled to undergo de novo AF ablation. They were randomized to an intensive risk factor management (RFM) program versus usual care. The RFM program addressed obesity, sleep apnea, HTN, HLD, tobacco, and alcohol abuse, whereas the usual care arm had a discussion of risk factors but without an extensive risk factor modification or follow-up program. The study population had a mean age of 60 years, a mean BMI of 33 kg/m2, and 56-60% of patients with persistent AF. A third of the study population was female. The trial showed a significant improvement in the primary endpoint of the percentage of patients free from atrial fibrillation after ablation in those receiving the intensive lifestyle RFM program. At the end of the 12.3-month follow-up period, 66% percent of patients in the RFM group were free from AF compared to 42% in the usual care group (HR 0.53, p = 0.03). The RFM group also showed significant improvement in AF symptom severity, decline in body weight, systolic blood pressure, glycemic control, and exercise capacity. On average, patients in the RFM arm lost 9 kg of weight compared to 1 kg in the control group. Similarly, systolic blood pressure decreased by 13.1 mmHg in the RFM group but increased by four mmHg in the control group.
This episode was planned in collaboration with Heart Rhythm TV with mentorship from Dr. Daniel Alyesh and Dr. Mehak Dhande.
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References - The SUMMIT Trial
Pathak, Rajeev K., et al. "Aggressive Risk Factor Reduction Study for Atrial Fibrillation and Implications for the Outcome of Ablation: The ARREST-AF Cohort Study." Journal of the American College of Cardiology, vol. 64, no. 21, 2014, pp. 2222–2231.
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