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June 27, 2026EP EuropaceOpen Access

Significant weight loss plus antiarrhythmic drugs achieves similar 12-month AF burden to catheter ablation.

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Why the study?

Does significant weight reduction combined with antiarrhythmic drugs reduce AF burden comparably to catheter ablation in patients with AF and BMI 30-40?

Population

182 patients with atrial fibrillation and BMI 30-40. Mean age 60, 31-32% women, 54-56% paroxysmal AF.

Comparison

Lifestyle modification combined with… vs Catheter ablation (CA)

Design

Cohort, Original trial was randomized; this is a per-protocol sub-analysis…

Follow-up

12 months

Key result

Significant weight reduction (>8.3%) combined with antiarrhythmic drugs resulted in a median AF burden at 12 months (0%) that did not differ significantly from catheter ablation (0%, p=0.17).

Authors

DHD HermanJVJ VeselaTRT Roubicek

Discussion

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Overview

AF burden remained higher with lifestyle modification plus drugs despite weight loss; leaves open optimal LFM dosing or combinations versus ablation.

Key Points

  • The study aims to evaluate the relationship between weight loss and atrial fibrillation (AF) burden at 12 months post-randomization.
  • Per-protocol analysis of the PRAGUE-25 trial
  • Patients in the lifestyle modification plus antiarrhythmic drugs group were stratified into tertiles based on weight reduction
  • Comparison of AF burden between the tertiles and catheter ablation group.
  • Among 83 LFM+AAD patients, 28 achieved a weight reduction >8.3%, 27 between 3.1–8.3%, and 28 <3.1%.
  • AF burden at 12 months was significantly higher in the second and third tertiles compared to catheter ablation, but not in the first tertile (p=0.17).
  • Significant weight reduction combined with AADs approaches catheter ablation effectiveness.

Study Design

Type

RCT (n=182)

Structured PICO

Does significant weight reduction combined with antiarrhythmic drugs reduce AF burden comparably to catheter ablation in patients with AF and BMI 30-40?

P
Population
182 patients with atrial fibrillation and BMI 30-40, followed for 12 months to assess AF burden.
I
Intervention
Lifestyle modification (weight reduction, alcohol intake reduction, increase in physical exercise) combined with antiarrhythmic drugs (AAD), stratified by achieved weight reduction tertiles (>8.3%, 3.1-8.3%, <3.1%)
C
Comparator
Catheter ablation (CA)
O
Outcome
Atrial fibrillation (AF) burden at 12 monthssurrogate

Main Result

Absolute Event Rate: 0% vs 0%

p-value: p=0.17

In patients with AF and obesity, achieving a weight reduction of >8.3% combined with antiarrhythmic drugs results in an AF burden at 12 months comparable to that achieved with catheter ablation.

Cite This Study

Herman et al. (2026) conducted an RCT in Atrial fibrillation (AF) and BMI 30-40 (n=182). Lifestyle modification (weight reduction) + antiarrhythmic drugs (AAD) vs. Catheter ablation (CA) was evaluated on AF burden at 12 months (p=0.17). Significant weight reduction (>8.3%) combined with antiarrhythmic drugs resulted in a median AF burden at 12 months (0%) that did not differ significantly from catheter ablation (0%, p=0.17).

synapsesocial.com/papers/6a3f97a5125782b61d8658c9https://doi.org/10.1093/europace/euag105.648
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