Lifestyle Changes Reduce AF Recurrence After Ablation

Aggressive lifestyle and risk factor modification (LRFM) was found to significantly reduce the occurrence of atrial fibrillation (AF) in symptomatic patients with AF undergoing ablation, according to a new study published in JAMA Cardiology.1

AF is growing in prevalence and disease burden, as it is largely influenced by other cardiac risk factors, which include hypertension, diabetes, obesity, obstructive sleep apnea, and heart failure.1,2 Catheter ablation is a well-known, effective therapy for treating AF, reducing recurrence, and improving clinical end points.1 Catheter ablation was also seen as an effective treatment for patients with heart failure with preserved ejection fraction and AF, but no improvement was seen in patients with heart failure with preserved ejection fraction.2

Modifiable cardiac risks not only increase the prevalence of AF but also the risk of recurrence. Researchers predicted that with aggressive LFRM, patients may reduce their risk of AF progression and recurrence by alleviating cardiometabolic comorbidities; however, more research is needed to determine its impact.

Patients who adopt intensive lifestyle and risk factor modifications after ablation show improved long-term atrial rhythm stability. | Image Credit: Shapla - stock.adobe.com

The multicenter, open-label, randomized clinical trial ARREST-RF assessed patients who underwent consecutive catheter ablation for AF between July 2, 2014, and September 7, 2017, with a 12-month follow-up. Patients were randomized 1:1 into the LRFM group or the usual care (UC) group. The LRFM group attended a physician-directed LRFM clinic every 3 months. Their blood pressure was measured twice daily at home, and they received a structured, motivational, face-to-face, and goal-directed program for weight reduction.

In contrast, the UC group was only given information on management of risk, which included written and verbal advice on health, nutrition, and exercise guidelines, but was not enrolled in the LRFM clinic.

LRFM Impact on Patients With AF

The final cohort included 122 patients with a mean age of 60 years, of whom 40 were female and 82 were male. There were 62 patients randomly assigned to the LRFM group and 60 to the UC group.

Twelve months after the catheter ablation, 38 of the 62 patients in the LRFM group remained free from atrial arrhythmia, when compared with the 24 of 60 patients in the UC group. The hazard ratio in time-to-event analysis was 0.53 (95% CI, 0.32-0.89), thus demonstrating a significant reduction of recurrence in the LRFM group when compared with the UC group.

AF burden was nearly non-existent in both groups. It remained the same throughout all 3 check-in points within the 12-month follow-up. However, repeat ablation was necessary for 10 of the 62 patients in the LRFM group and 16 of the 60 patients in the UC group. At the end of the 12-month follow-up, only 13 of the 62 LRFM group patients reported an absence of any AF-related symptoms when compared with the 3 of 60 in the UC group.

Overall, the burden of symptoms as a result of the catheter ablation was lower in the LRFM group when compared with the UC group in regard to symptom frequency (mean difference, −2.8 points; 95% CI, −3.8 to −1.9), duration (mean difference, −2.4 points; 95% CI, −3.5 to −1.2), and episode severity (mean difference, −0.8; 95% CI, −1.5 to −0.1).

Cardiometabolic risk factors were more favorable in the LRFM group, as they had lower body weight, waist circumference, and systolic BP at 12 months when compared with the UC group.

No serious adverse events were seen in either group at the 12-month follow-up. However, 2 patients in the LRFM group experienced either procedural pericardial effusion or pseudoaneurysm, whereas 1 patient in the UC group developed pericarditis. Furthermore, 2 patients in the UC group and 3 patients in the LRFM group experienced posterior wall temperature rise, thus limiting catheter ablation.

Next Steps

The study was limited by its lack of generalizability, as it was conducted across multiple centers in Australia. Therefore, its feasibility may not be generalizable to other geographic regions, healthcare systems, or culturally and racially diverse populations. Furthermore, targeted LRFM components were broad and therefore limited insights into the individual contribution of specific risk factors.

“These findings emphasize that beyond the catheter-based intervention, addressing the LRF drivers of progressive remodeling is critical to achieving the highest rate of long-term sinus rhythm maintenance,” the study authors concluded.

References

1. Pathak RK, Elliott AD, Lau DH, et al. Aggressive risk factor reduction study for atrial fibrillation implications for ablation outcomes: the ARREST-AF randomized clinical trial. JAMA Cardiol. Published online October 29, 2025. doi:10.1001/jamacardio.2025.4007

2. Oraii A, McIntyre WF, Parkash R, et al. Atrial fibrillation ablation in heart failure with reduced vs preserved ejection fraction: a systematic review and meta-analysis. JAMA Cardiol. 2024;9(6):545–555. doi:10.1001/jamacardio.2024.0675