Supervised Obesity Reduction Trial for AF Ablation Patients: Results from the SORT-AF Trial

Overview

Journal Europace

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
Physiology

Date 2021 Apr 25

PMID 33895833

Citations 32

Authors

Nele Gessler

Stephan Willems

Daniel Steven

Jens Aberle

Ruken Oezge Akbulak

Nils Gosau

Boris A Hoffmann

Christian Meyer

Arian Sultan

Roland Tilz

Julia Vogler

Peter Wohlmuth

Susanne Scholz

Melanie A Gunawardene

Christian Eickholt

Jakob Luker

Affiliations

Soon will be listed here.

Abstract

Aims: Weight management seems to be beneficial for obese atrial fibrillation (AF) patients; however, randomized data are sparse. Thus, this study aimed to investigate the influence of weight reduction on AF ablation outcomes.

Methods And Results: SORT-AF is an investigator-sponsored, prospective, randomized, multicentre, and clinical trial. Patients with symptomatic AF (paroxysmal or persistent) and body mass index (BMI) 30-40 kg/m2 underwent AF ablation and were randomized to either weight-reduction (group 1) or usual care (group 2), after sleep-apnoea-screening and loop recorder (ILR) implantation. The primary endpoint was defined as AF burden between 3 and 12 months after AF ablation. Overall, 133 patients (60 ± 10 years, 57% persistent AF) were randomized to group 1 (n = 67) and group 2 (n = 66), respectively. Complications after AF-ablation were rare (one stroke and no tamponade). The intervention led to a significant reduction of BMI (34.9 ± 2.6-33.4 ± 3.6) in group 1 compared to a stable BMI in group 2 (P < 0.001). Atrial fibrillation burden after ablation decreased significantly (P < 0.001), with no significant difference regarding the primary endpoint between the groups (P = 0.815, odds ratio: 1.143, confidence interval: 0.369-3.613). Further analyses showed a significant correlation between BMI and AF recurrence for patients with persistent AF compared with paroxysmal AF patients (P = 0.032).

Conclusion: The SORT-AF study shows that AF ablation is safe and successful in obese patients using continuous monitoring via ILR. Although the primary endpoint of AF burden after ablation did not differ between the two groups, the effects of weight loss and improvement of exercise activity were beneficial for obese patients with persistent AF demonstrating the relevance of life-style management as an important adjunct to AF ablation in this setting.

Trial Registration Number: NCT02064114.

Citing Articles

Cryoballoon Pulmonary Vein Isolation in Obese Patients with Atrial Fibrillation Compared to Non-Obese Counterparts: A Meta-Analysis.

Vrachatis D, Papathanasiou K, Kazantzis D, Anagnostopoulos I, Kousta M, Giotaki S Biomedicines. 2025; 13(2).

PMID: 40002711 PMC: 11852532. DOI: 10.3390/biomedicines13020298.

Weight reduction interventions for the management of atrial fibrillation in overweight and obese people.

Valli H, Tindale A, Butt H, Beattie C, Adasuriya G, Warraich M Cochrane Database Syst Rev. 2025; 5:CD014768.

PMID: 39908074 PMC: 11091950. DOI: 10.1002/14651858.CD014768.

Advances in Atrial Fibrillation Management: A Guide for General Internists.

Pham H, Ibrahim R, Truong H, Sainbayar E, Tran V, Abdelnabi M J Clin Med. 2025; 13(24.

PMID: 39768769 PMC: 11678337. DOI: 10.3390/jcm13247846.

Upstream targeting for the prevention of atrial fibrillation: Targeting Risk Interventions and Metformin for Atrial Fibrillation (TRIM-AF)-rationale and study design.

Wass S, Barnard J, Kim H, Sun H, Telfer W, Schilling T J Interv Card Electrophysiol. 2024; 68(1):9-19.

PMID: 39671157 PMC: 11832320. DOI: 10.1007/s10840-024-01955-z.

2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.

Tzeis S, Gerstenfeld E, Kalman J, Saad E, Sepehri Shamloo A, Andrade J J Arrhythm. 2024; 40(6):1217-1354.

PMID: 39669937 PMC: 11632303. DOI: 10.1002/joa3.13082.

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