ARREST-AF: The true impact of risk factor management on AF recurrence after ablation

Risk factor management improved atrial fibrillation (AF) recurrence rates, symptom burden, and the risk factor profile of patients undergoing ablation for AF in the randomised-controlled ARREST-AF study.

The ARREST-AF trial investigated the effect of risk factor management on AF recurrence after ablation for AF. For this purpose, Prof. Rajeev Pathak (University of Adelaide, Australia) and colleagues enrolled patients with paroxysmal or persistent AF undergoing de novo AF ablation [1]. Other inclusion criteria were a BMI of at least 27 kg/m², a waist circumference of over 100 cm (men) or 90 cm (women), and at least 1 cardiovascular risk factor. The research team recruited 122 participants who were randomised 1:1 to usual care or aggressive risk factor management.

After a mean follow-up of 12.3 months, Dr Pathak and colleagues noted a significant weight reduction in the risk management group compared with the usual-care group (P<0.001), a significant drop in systolic blood pressure in the risk management group compared with the usual-care group (P<0.001), and an increase of approximately 1 metabolic equivalent (MET) in exercise capacity in the experimental group (P=0.003). The primary outcome of arrhythmia-free survival was met, with rates of 61.3% and 40.0% in the risk management group and control group, respectively (HR 0.53; 95% CI 0.32–0.89; P=0.03). Finally, the AFSS questionnaire displayed a significant reduction in symptom frequency, symptom duration, and symptom severity in the experimental arm compared with the control arm.

“Comprehensive lifestyle and risk factor management resulted in improved AF recurrence rates and symptom burden for the study population,” concluded Dr Pathak. “Future studies should look into the relative contribution of each risk factor.”

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   1. Pathak RK, et al. Aggressive risk factor reduction study for atrial fibrillation (ARREST-AF) implications for ablation outcomes: a randomized clinical trial. LBS.07, AHA Scientific Sessions 2024, 16–18 November, Chicago, USA.

Medical writing support was provided by Robert van den Heuvel.
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Posted on 19 November 2024