ARREST AFIB trial
Dr. Dennis Lau from Adelaide, Australia made this analogy at the Heart Rhythm Society meeting in San Francisco. He works with Dr. Prasanthan Sanders’ group. This group published one of the seminal studies regarding lifestyle and AFIB – the ARREST AFIB trial.
Lifestyle factors that lead to AFIB are like the leaking roof. We can attempt to fix the rotting timber (with ablation and drugs) but unless we address the leaking roof with lifestyle modification, the treatment of AFIB is bound to fail.
RFM (Risk Factor Modification) targeted the following 6 variables:
- Blood pressure control
- Weight management
- Lipid management
- Glycemic (blood sugar) management
- Sleep disordered breathing management
- Smoking and alcohol
There are 4 pillars in the management of AFIB. RFM is the first one of them.
Reasons why risk factor modification works:
The study group was involved in a formal risk factor modification program. The control group was given information on management of risk factors. However, they continued RFM under the direction of their treating physician.
Both groups underwent ablation and usual management of AFIB at similar rates.
This study found that in patients with highly symptomatic AF undergoing ablation, a structured physician-directed risk factor and weight management program resulted in significant improvement in the long-term outcomes. These effects were associated with structural remodeling, with significant improvement in LA volumes and LV hypertrophy. The findings emphasize the importance of treating the underlying causes of AF to achieve rhythm control and maintenance of sinus rhythm.
