Aggressive Risk Factor Reduction Study for Atrial Fibrillation Implications for Ablation Outcomes: The ARREST-AF Randomized Clinical Trial.

Although observational studies have reported reduced arrhythmia recurrence after AF ablation with aggressive lifestyle and risk factor modification, evidence from randomized clinical trials is lacking.

尽管观察性研究报道了在AF消融后通过积极的生活方式和风险因素的改变减少了心律失常的复发，但来自随机临床试验的证据仍然缺乏。

Background

To determine the impact of risk factor and weight management on AF ablation rhythm outcomes.

确定风险因素和体重管理对房颤消融节律结果的影响。

DESIGN, SETTING, AND PARTICIPANTS: This was an open-label, multicenter, randomized clinical trial with 12-month follow-up conducted from July 2014 to September 2018.

设计、环境和参与者：这是一项开放标签、多中心、随机临床试验，随访期为12个月，从2014年7月到2018年9月进行。

The setting included 3 sites in Adelaide, South Australia.

研究地点包括南澳大利亚州阿德莱德的3个场所。

Included in the analysis were consecutive patients with nonpermanent symptomatic AF undergoing first-time catheter ablation with a body mass index (BMI) greater than or equal to 27 (calculated as weight in kilograms divided by height in meters squared) and 1 or more additional cardiometabolic risk factors.

分析中包括了连续的非永久性症状性房颤患者，这些患者首次接受导管消融治疗，体重指数（BMI）大于或等于27（按体重公斤数除以身高米数的平方计算），并且有1个或更多的心血管代谢风险因素。

Data were analyzed from September 2023 to August 2024.

数据分析的时间范围是从2023年9月至2024年8月。

Methods

Patients were randomized 1:1 to lifestyle and risk factor management (LRFM) or usual care (UC) at catheter ablation.

患者在导管消融时按照1:1的比例随机分为生活方式和风险因素管理组（LRFM）或常规护理组（UC）。

The LRFM group was treated in a structured, physician-led tailored clinic to reduce modifiable risk factors.

LRFM 组接受了结构化的、由医生领导的定制化诊所治疗，以减少可修改的风险因素。

The UC group was given information on management of risk factors by their treating physician but were not enrolled into the risk factor modification clinic.

UC 组由其治疗医生提供了关于风险因素管理的信息，但未被纳入风险因素修改诊所。

Both groups received guideline-directed care for management of AF by a team blinded to randomization.

两组患者均接受了由对随机分组情况不知情的团队指导的房颤管理指南推荐治疗。

Pulmonary vein isolation was undertaken in each patient with additional ablation considered at the discretion of the electrophysiologist.

每位患者均进行了肺静脉隔离术，是否进行额外消融由电生理学家酌情决定。

main_outcomes_and_measures

Proportion of patients free from AF in the 12-month period after ablation.

消融后12个月内无房颤患者的比率。

Results

Of 122 participants (mean [SD] age, 60 [10] years; 82 male [67%]; mean [SD] BMI, 33 [5]), 62 were randomized to LRFM, and 60 were randomized to UC.

在122名参与者中（平均[标准差]年龄为60[10]岁；82名为男性[67%]；平均[标准差]体质指数为33[5]），62人被随机分配到LRFM组，60人被随机分配到UC组。

Primary end point at 12 months after ablation was observed in 38 patients (61.3%) in the LRFM group and 24 (40%) in the control group (P = .03).

消融后12个月，LRFM组有38名患者（61.3%）和对照组有24名患者（40%）达到主要终点（P = .03）。

The hazard for recurrent arrhythmia over 12 months was 0.53 (95% CI, 0.32-0.89) for LRFM vs UC.

在12个月内，LRFM与UC相比，复发性心律失常的风险为0.53（95%置信区间，0.32-0.89）。

AF symptom severity was significantly improved in the LRFM group compared with the UC group (mean difference, -2.0; 95% CI, -3.7 to -0.3).

与UC组相比，LRFM组的AF症状严重程度显著改善（平均差异，-2.0；95%置信区间，-3.7至-0.3）。

Patients in the LRFM group achieved a significantly improved risk factor profile compared with those in the UC group (mean difference, body weight, -9.0 kg; 95% CI, -11.1 to -6.8 kg and waist circumference, -7.0 cm; 95% CI, -9.4 to -4.5 cm were lower at 12 months in the LRFM group; systolic BP was lower at 12 months in the LRFM group, -10.8 mm Hg; 95% CI, -16.1 to -5.5 mm Hg, although there was no difference in diastolic BP, -3.5 mm Hg; 95% CI, -7.2 to 0.2 mm Hg).

与UC组相比，LRFM组患者的危险因素特征显著改善（平均差异，体重-9.0公斤；95%置信区间，-11.1至-6.8公斤，腰围-7.0厘米；95%置信区间，-9.4至-4.5厘米，在12个月时LRFM组较低；收缩压在12个月时LRFM组较低，-10.8毫米汞柱；95%置信区间，-16.1至-5.5毫米汞柱，尽管舒张压没有差异，-3.5毫米汞柱；95%置信区间，-7.2至0.2毫米汞柱）。

conclusions_and_relevance

Among patients with AF, elevated BMI, and 1 or more additional cardiometabolic risk factors, aggressive risk factor management reduced arrhythmia recurrence over the 12-month period after catheter ablation.

在房颤、高体质指数以及1个或更多其他心代谢风险因素的患者中，积极的风险因素管理在导管消融后12个月的期间内降低了心律失常的复发率。

These findings demonstrate the importance of LRFM for the maintenance of sinus rhythm after catheter ablation.

这些发现展示了长期风险因素管理（LRFM）对于导管消融后维持窦性心律的重要性。

trial_registration

ANZCTR Registry Identifier: ACTRN12613000444785.

ANZCTR注册标识符：ACTRN12613000444785。