Gewichtsverlies verbetert metabole profielen maar verlaagt AF-herhaling niet na ablatie — HOBIT-AF

AIMS: Obesity is one of the strongest risk factors for the development of atrial fibrillation (AF), and its reduction is associated with the alleviation of AF burden. The HOBIT-AF study aimed to evaluate the impact of complex weight loss interventions on AF recurrence rate in obese individuals after catheter ablation (CA). METHODS AND RESULTS: The HOBIT-AF was a randomized controlled trial with a 15-month treatment period (3-18 months post CA) involving complex weight-reducing interventions in the active arm. The primary outcome was the change in AF/atrial tachycardia (AT) burden assessed from baseline and the final 14-day Holter monitoring. A total of 167 individuals (aged 59 years, body mass index of 35.6 kg/m2) were randomized into the active (n = 85) and control group (n = 82). At the end of the treatment period, a mean reduction of 6.8 ± 7.0% of the initial body weight accompanied by improvement of metabolic parameters was achieved in the active group. The AF/AT burden change was 0.6 ± 2.5% (95% CI: -4.2-5.5%) in the active group and -0.9 ± 1.8% (95% CI: -4.5-3.0%) in the control group. The AF/AT recurrence-free survival during the 3-18-month follow-up period was comparable between groups (70.4% vs. 69.6%). CONCLUSION: HOBIT-AF trial showed that despite the beneficial effect of body weight reduction on metabolic profile of obese patients with predominantly paroxysmal AF after CA, no reduction in AF/AT recurrence was observed in comparison with control patients. This may be likely due to low AF burden after previous CA, limiting further improvement.