Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation

BACKGROUND: Obesity is an important risk factor for atrial fibrillation (AF). Nonrandomized studies have shown that weight loss and increased physical activity are associated with AF reduction. OBJECTIVES: The goal of this study was to assess whether treatment based on lifestyle modification (LFM; directed weight loss and physical exercise) in combination with antiarrhythmic drugs (AADs) is noninferior to catheter ablation (CA) in patients with AF and obesity. METHODS: . Patients were randomized to the CA vs LFM+AAD groups in a 1:1 ratio. Seven-day electrocardiographic Holter recordings were performed every 3 months. The primary endpoint was AF freedom during the 12 months after randomization (ie, absence of any AF episode lasting >30 s; the blanking period was 3 months). Secondary endpoints included AF burden, peak oxygen uptake during cardiopulmonary exercise testing, changes in metabolic parameters, and quality of life as assessed with the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire, all compared between randomization and 12 months. RESULTS: , were more significant in the LFM+AAD group than in the CA group. CONCLUSIONS: Despite important metabolic improvements associated with LFM, CA was superior to LFM combined with AADs in improving freedom from AF at 1 year in patients with AF and obesity.