Department of Medicine, Section of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Department of Medicine, Section of Cardiovascular Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
J Cardiovasc Electrophysiol. 2023 Dec;34(12):2514-2526. doi: 10.1111/jce.16090. Epub 2023 Oct 3.
Obesity is associated with an increased risk of developing recurrent atrial fibrillation (AF) after catheter ablation (CA). However, the current data on weight loss interventions show inconsistent results in preventing the recurrence of AF after CA.
We conducted a systematic search in MEDLINE and EMBASE to identify studies that reported the outcome of recurrence of AF after CA in obese patients undergoing weight interventions. The subgroup analysis included: (1) Weight loss versus no weight loss, (2) >10% weight loss versus <10% weight loss, (3) <10% weight loss versus no weight loss, (4) Follow-up <12 months, and (5) Follow-up >12 months after CA. Mantel-Haenszel risk ratios with a 95% confidence interval (CI) were calculated using a random effects model and for heterogeneity, I statistics were reported.
A total of 10 studies (one randomized controlled trial and nine observational studies) comprising 1851 patients were included. The recurrence of AF was numerically reduced in the weight loss group (34.5%) versus no weight loss group (58.2%), but no statistically significant difference was observed (risk ratio [RR] = 0.76; 95% CI: 0.49-1.18, p = .22). However, there was a statistically significant reduction in recurrence of AF with weight loss versus no weight loss at follow-up >12 months after CA (RR = 0.47; 95% CI: 0.32-0.68, p < .0001). At follow-up >12 months after CA, both >10% weight loss versus <10% weight loss (RR = 0.49; 95% CI: 0.31-0.80, p = .004) and <10% weight loss versus no weight loss (RR = 0.39; 95% CI: 0.31-0.49, p < .00001) were associated with a statistically significant reduction in recurrent AF.
In patients with AF undergoing CA, weight loss is associated with reducing recurrent AF at > 12 months after ablation and these benefits are consistently seen with both >10% and <10% weight loss. The benefits of weight loss in preventing recurrent AF after CA should be examined in larger studies with extended follow-up duration.
肥胖与导管消融（CA）后复发性心房颤动（AF）的风险增加有关。然而，目前关于体重干预的研究数据在预防 CA 后 AF 复发方面结果不一致。
我们在 MEDLINE 和 EMBASE 中进行了系统检索，以确定报告肥胖患者在接受体重干预后 CA 后 AF 复发结果的研究。亚组分析包括：（1）体重减轻与无体重减轻，（2）体重减轻> 10%与体重减轻< 10%，（3）体重减轻< 10%与无体重减轻，（4）随访< 12 个月，（5）CA 后随访> 12 个月。使用随机效应模型计算 Mantel-Haenszel 风险比和 95%置信区间（CI），并报告异质性 I 统计量。
共纳入 10 项研究（1 项随机对照试验和 9 项观察性研究），共纳入 1851 例患者。与无体重减轻组（58.2%）相比，体重减轻组（34.5%）AF 复发的发生率降低，但无统计学意义（风险比[RR] = 0.76；95%CI：0.49-1.18，p = 0.22）。然而，在 CA 后随访> 12 个月时，体重减轻与无体重减轻相比，AF 复发的发生率有统计学意义降低（RR = 0.47；95%CI：0.32-0.68，p<0.0001）。在 CA 后随访> 12 个月时，与体重减轻< 10%相比，体重减轻> 10%（RR = 0.49；95%CI：0.31-0.80，p = 0.004）和体重减轻< 10%（RR = 0.39；95%CI：0.31-0.49，p<0.00001）与 AF 复发的发生率降低有统计学意义。
在接受 CA 的 AF 患者中，体重减轻与消融后> 12 个月时 AF 复发减少有关，这些益处在体重减轻> 10%和< 10%时均一致观察到。在更大的研究中，应进一步延长随访时间，以确定体重减轻在预防 CA 后 AF 复发中的益处。
