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Journal of the American College of Cardiology

Clinical Articles, News & Views

Long-term weight loss reduces AF

Long-term sustained weight-loss is associated with significant reduction of atrial fibrillation (AF) burden and maintenance of sinus rhythm, making this an important strategy for reducing the rising burden of the condition, according to results from LEGACY (Long-Term Effect of Goal Directed Weight Management in an Atrial Fibrillation Cohort: A Long-term Follow-Up StudY) published recently in the Journal of the American College of Cardiology.1

The study showed that, of 1,415 consecutive patients with AF, 825 had body mass index (BMI) ≥27 kg/m2 and were offered weight management. After screening for exclusion criteria, 355 were included in this analysis. To determine a dose-response, weight-loss was categorised as: Group-1 (>10%); Group-2 (3–9%); and Group-3 (<3%). Weight trend/fluctuation was determined by yearly follow-up. The authors determined the impact on AF severity scale and 7-day ambulatory monitoring.

There were no differences in baseline characteristics or follow-up duration between the groups (p=NS). At follow-up, AF burden and symptom severity decreased more in Group-1 compared to Group-2 and 3 (p<0.001 for all). Arrhythmia-free survival both with and without rhythm control strategies (medication or ablation) was greatest in Group-1 compared to Group-2 and 3 (P<0.001 for both).

In multivariate analyses, weight-loss Group (p<0.001) and weight-fluctuation (p<0.001) were independent predictors of outcomes. Weight-loss >10% resulted in a six-fold (95% CI: 3.4-10.3, p<0.001) greater probability of arrhythmia-free survival compared to other two groups. Greater than 5% weight-fluctuation partially offsets this benefit with a two-fold (95% CI 1.0-4.3; p =0.02) increased risk of arrhythmia recurrence.


1. Pathak RK, Middeldorp ME, Meredith M, et al. Long-term effect of goal directed weight management in an atrial fibrillation cohort: a long-term follow-up study (LEGACY Study). J Am Coll Cardiol 2015.

Published on: March 27, 2015

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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