Article

Supervised Obesity Reduction Trial for AF ablation patients: results from the SORT-AF trial

Nele GeßlerDepartment of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, GermanyStephan WillemsAtrial Fibrillation Network (AFNET), Münster, GermanyDaniel StevenDepartment of Electrophysiology, University of Cologne, University Hospital Cologne, Cologne, GermanyJens AberleCenter for Internal Medicine, Section Endocrinology, University Hospital Eppendorf, Hamburg, GermanyRuken Oezge AkbulakDepartment of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, GermanyNils GosauDepartment of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, GermanyBoris HoffmannDepartment of Cardiology, Faculty of Medicine, Asklepios Clinic Harburg, Semmelweis University Campus Hamburg, Hamburg, GermanyChristian MeyerDepartment of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Düsseldorf, GermanyArian SultanDepartment of Electrophysiology, University of Cologne, University Hospital Cologne, Cologne, GermanyRoland Richard TilzDivision of Electrophysiology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyJulia VoglerDivision of Electrophysiology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, GermanyPeter WohlmuthAsklepios Proresearch, Hamburg, GermanySusanne ScholzDepartment of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, GermanyMelanie GunawardeneDepartment of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, GermanyChristian EickholtDepartment of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, GermanyJakob LükerDepartment of Electrophysiology, University of Cologne, University Hospital Cologne, Cologne, Germany

2021en

ABI

Abstract

AIMS: Weight management seems to be beneficial for obese atrial fibrillation (AF) patients; however, randomized data are sparse. Thus, this study aimed to investigate the influence of weight reduction on AF ablation outcomes. METHODS AND RESULTS: SORT-AF is an investigator-sponsored, prospective, randomized, multicentre, and clinical trial. Patients with symptomatic AF (paroxysmal or persistent) and body mass index (BMI) 30-40 kg/m2 underwent AF ablation and were randomized to either weight-reduction (group 1) or usual care (group 2), after sleep-apnoea-screening and loop recorder (ILR) implantation. The primary endpoint was defined as AF burden between 3 and 12 months after AF ablation. Overall, 133 patients (60 ± 10 years, 57% persistent AF) were randomized to group 1 (n = 67) and group 2 (n = 66), respectively. Complications after AF-ablation were rare (one stroke and no tamponade). The intervention led to a significant reduction of BMI (34.9 ± 2.6-33.4 ± 3.6) in group 1 compared to a stable BMI in group 2 (P < 0.001). Atrial fibrillation burden after ablation decreased significantly (P < 0.001), with no significant difference regarding the primary endpoint between the groups (P = 0.815, odds ratio: 1.143, confidence interval: 0.369-3.613). Further analyses showed a significant correlation between BMI and AF recurrence for patients with persistent AF compared with paroxysmal AF patients (P = 0.032). CONCLUSION: The SORT-AF study shows that AF ablation is safe and successful in obese patients using continuous monitoring via ILR. Although the primary endpoint of AF burden after ablation did not differ between the two groups, the effects of weight loss and improvement of exercise activity were beneficial for obese patients with persistent AF demonstrating the relevance of life-style management as an important adjunct to AF ablation in this setting. TRIAL REGISTRATION NUMBER: NCT02064114.

Identifiers

DOI: 10.1093/europace/euab122

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