Improving outcomes of atrial fibrillation ablation by integrated personalized lifestyle interventions: a randomized controlled trial

Abstract Background and Aims Atrial fibrillation (AF) is associated with various lifestyle risk factors. Their presence negatively affects AF catheter ablation outcomes. This study evaluates the efficacy of a nurse-led, integrated lifestyle programme on ablation outcomes. Methods POP-AF is a prospective, randomized, controlled trial involving patients referred for their first AF ablation. Patients were assigned in a 1:1 ratio to standard pre-ablation counselling by the treating electrophysiologist, or a nurse-led integrated lifestyle clinic, including a home sleep apnea test, weight reduction, alcohol reduction, smoking cessation, and optimal hypertension and hypercholesterolemia treatment before undergoing pulmonary vein isolation (PVI). The primary endpoint was a composite of hospitalizations for repeat ablations and direct current cardioversions in an event-rate analysis up to 12 months after pulsed-field PVI. Results A total of 145 patients participated in the trial; 70 patients were assigned to the control group, and 75 patients were assigned to the integrated lifestyle treatment (ILT) group. The median age of patients was 62 years, 26% were women, and 59% had persistent AF. Median ILT duration was 5 months. The primary endpoint occurred 52 times (492/1000 patient-years) in the control group and 25 times (240/1000 patient-years) in the ILT group (incidence relative risk [RR] 0.49, 95% confidence interval [CI] 0.30-0.78, P=0.004). The rates of repeat ablations (RR 0.43, 95% CI 0.18-0.94, P=0.045) and direct current cardioversions (RR 0.52, 95% CI 0.28-0.92, P=0.031) were also lower in the ILT group. Conclusions Integrated lifestyle modification before catheter ablation reduces both repeat ablations and direct current cardioversions by half until 12 months after index ablation.