Effect of Weight Loss Amplitude Combined with Antiarrhythmic Drugs on Atrial Fibrillation Freedom, as compared to Catheter Ablation: A Sub-Analysis of the PRAGUE-25 Trial
Year: 2026
Type: article
Abstract: BACKGROUND AND AIMS: In the PRAGUE-25 study, the effect of lifestyle modification (LFM) in combination with antiarrhythmic drugs (AAD) in patients with atrial fibrillation (AF) and BMI 30-40 was smaller than that of catheter ablation (CA). The presented sub-analysis aims to assess the relationship between the actual weight reduction and the AF burden 12 months after randomization. METHODS: Per-protocol analysis of the PRAGUE-25 trial. Patients in the LFM+AAD group were stratified into tertiles based on the extent of relative weight reduction, and a comparison of AF burden was performed between the LFM+AAD tertiles and the CA group. RESULTS: The study analyzed 83 LFM+AAD patients (age 60 ±9 years, 31% women, 54% paroxysmal AF, mean weight 109±17 kg) and 99 CA patients (age 60±9 years, 32% women, 56% paroxysmal AF, weight 109±15 kg). Within the LFM+AAD group, 28 patients achieved a weight reduction of >8.3% (-15.46±6.16 kg), 27 patients were between 3.1-8.1% (-6.56±2.28 kg), and 28 patients were <3.1% (+1.38±4.03 kg). Compared to the CA group, the AF burden at 12 months (0 [IQR 0-0]) was significantly higher in the second (3.5% [0; 52] and third (1[0; 47] LFM-ADD tertiles, but did not differ from CA in the first tertile (0% [0; 11.], p=0.17). CONCLUSION: In obese patients, the maintenance of SR on AADs is related to the level of weight reduction. The efficacy of AADs in obese patients with a significant weight loss at 12-months follow-up is close to catheter ablation, although the overall AF burden is still non-significantly higher.
Source: EP Europace
Authors: Dalibor Heřman, Jana Veselá, Tomas Roubicek, Stepan Havranek, Jan Chovancik, Veronika Bulkova, Marek Hozman, Ivan Ranic, Jana Hozmanova, Martin Matoulek, Vladimir Tuka, Adam Latinak, Jan Pidhorodecky, Milan Dusik, Jan Simek, Zuzana Hejdukova, Otakar Jiravsky, Bogna Jiravska–Godula, Frantisek Lehar, Hana Zelinkova, Jiri Jarkovsky, Klara Benesova, Pavel Osmancik
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,909
OpenAlex ID: W7124862344
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