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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EWeight loss in patients with atrial fibrillation and a body mass index \u0026gt;\u200527 kg\/m is associated with dose-dependent improved control of sinus rhythm and lower atrial fibrillation burden, according to the 5-year LEGACY study. However, \u0026gt;\u20055% weight fluctuation can offset these benefits.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eobesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eatrial fibrillation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eantiarrhythmic drugs\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eablation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eweight loss\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELEGACY\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EACTRN12614001123639\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Earrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiometabolic disorder\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\n\u003Cp id=\u0022p-2\u0022\u003ESteady, sustained weight loss can help control atrial fibrillation (AF) in overweight patients, even freeing some from the need for medications or surgical ablation. Rajeev K. Pathak, MBBS, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia, presented findings from the 5-year LEGACY trial [Pathak RK et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E. 2015].\u003C\/p\u003E\n\u003Cp id=\u0022p-3\u0022\u003EThe incidence of AF is increasing in concert with the global increase in the body mass index (BMI), perhaps in part because of the influence of shared risk factors for the metabolic syndrome, as suggested by the ARIC cohort study [Chamberlain AM et al. \u003Cem\u003EAm Heart J\u003C\/em\u003E. 2010]. In 2013, a smaller, 15-month study on short-term weight loss and metabolic risk factor management found reductions in AF symptoms and severity after a weight management intervention [Abed HS et al. \u003Cem\u003EJAMA.\u003C\/em\u003E 2013].\u003C\/p\u003E\n\u003Cp id=\u0022p-4\u0022\u003ELEGACY investigators enrolled 355 patients with AF and a BMI \u003Cem\u003E\u2265\u2005\u003C\/em\u003E27 kg\/m\u003Csup\u003E2\u003C\/sup\u003E who agreed to participate in a physician-led metabolic risk factor and weight management clinic. The study sought to determine whether there was a dose-dependent relationship between long-term weight loss and freedom from AF and the impact of fluctuations in weight on AF.\u003C\/p\u003E\n\u003Cp id=\u0022p-5\u0022\u003EThe co-primary outcomes were AF symptom burden measured by a validated questionnaire and freedom from AF by 7-day Holter monitoring. Secondary outcomes were the impact of weight loss on left atrial volume and left ventricular (LV) thickness, and metabolic and inflammatory risk factors.\u003C\/p\u003E\n\u003Cp id=\u0022p-6\u0022\u003EAfter participating in the clinic, patients were divided into 3 groups: group 1, \u003Cspan class=\u0022underline\u0022\u003E\u0026gt;\u003C\/span\u003E\u200510% weight loss (WL; n\u2005=\u2005135); group 2, 3% to 9% WL (n\u2005=\u2005103); and group 3, \u0026lt;\u20053% WL, or weight gain (n\u2005=\u2005117).\u003C\/p\u003E\n\u003Cp id=\u0022p-7\u0022\u003EBaseline characteristics, including age, BMI range, metabolic syndrome risk factors, coronary artery disease, and sleep apnea incidence, were similar across the groups. Annual follow-up determined changes in weight.\u003C\/p\u003E\n\u003Cp id=\u0022p-8\u0022\u003EA dose-dependent relationship between weight loss and risk factors for the metabolic syndrome was found. Stepwise reductions in AF frequency, severity, and duration were found, along with stepwise increases in global well-being scores. This was most marked in group 1, in which nearly half of patients had freedom from AF without medications or ablation (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Total arrhythmia-free survival was 86% in group 1, 66% in group 2, and 40% in group 3 (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001).\u003C\/p\u003E\n\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/5\/19\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Freedom From Antiarrhythmic Drugs, Ablation, and Atrial FibrillationAF, atrial fibrillation; WL, weight loss.Reprinted from J Am Coll Cardiol, Pathak RK et al. Long-term effect of goal directed weight management in an atrial fibrillation cohort: a long-term follow-up study (LEGACY Study). Article in Press, DOI: 10.1016\/j.jacc.2015.03.002. Copyright (2015), with permission from American College of Cardiology.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-902462586\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Freedom From Antiarrhythmic Drugs, Ablation, and Atrial FibrillationAF, atrial fibrillation; WL, weight loss.Reprinted from \u0026amp;lt;em\u0026amp;gt;J Am Coll Cardiol\u0026amp;lt;\/em\u0026amp;gt;, Pathak RK et al. Long-term effect of goal directed weight management in an atrial fibrillation cohort: a long-term follow-up study (LEGACY Study). Article in Press, DOI: 10.1016\/j.jacc.2015.03.002. Copyright (2015), with permission from American College of Cardiology.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/5\/19\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/5\/19\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/5\/19\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16201\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EFreedom From Antiarrhythmic Drugs, Ablation, and Atrial Fibrillation\u003C\/p\u003E\n\u003Cp id=\u0022p-10\u0022\u003EAF, atrial fibrillation; WL, weight loss.\u003C\/p\u003E\n\u003Cp id=\u0022p-11\u0022\u003EReprinted from \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E, Pathak RK et al. Long-term effect of goal directed weight management in an atrial fibrillation cohort: a long-term follow-up study (LEGACY Study). Article in Press, DOI: 10.1016\/j.jacc.2015.03.002. Copyright (2015), with permission from American College of Cardiology.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-12\u0022\u003EAccording to the multivariate analysis, a greater weight loss was associated with greater AF-free survival, while greater fluctuations in weight were associated with AF recurrence (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\n\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/5\/19\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Multivariate Predictors of Atrial Fibrillation-Free Survival and Atrial Fibrillation RecurrenceAF, atrial fibrillation.(A) \u0026#x2265; 10% weight loss was associated with AF-free survival (HR, 5.7; 95% CI, 3.3 to 10.1; P \u0026amp;lt; .001).(B) \u0026amp;gt; 5% weight fluctuation was associated with AF recurrence (HR, 2.2; 95% CI, 1.1 to 4.2; P \u0026amp;lt; .001).Reproduced with permission from RK Pathak, MBBS.Source: Pathak RK et al. J Am Coll Cardiol. 2015.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-902462586\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Multivariate Predictors of Atrial Fibrillation-Free Survival and Atrial Fibrillation RecurrenceAF, atrial fibrillation.(A) \u0026#x2265; 10% weight loss was associated with AF-free survival (HR, 5.7; 95% CI, 3.3 to 10.1; \u0026amp;lt;em\u0026amp;gt;P\u0026amp;lt;\/em\u0026amp;gt; \u0026amp;amp;lt; .001).(B) \u0026amp;amp;gt; 5% weight fluctuation was associated with AF recurrence (HR, 2.2; 95% CI, 1.1 to 4.2; \u0026amp;lt;em\u0026amp;gt;P\u0026amp;lt;\/em\u0026amp;gt; \u0026amp;amp;lt; .001).Reproduced with permission from RK Pathak, MBBS.Source: Pathak RK et al. \u0026amp;lt;em\u0026amp;gt;J Am Coll Cardiol\u0026amp;lt;\/em\u0026amp;gt;. 2015.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/5\/19\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/5\/19\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/5\/19\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16202\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003EMultivariate Predictors of Atrial Fibrillation-Free Survival and Atrial Fibrillation Recurrence\u003C\/p\u003E\n\u003Cp id=\u0022p-14\u0022\u003EAF, atrial fibrillation.\u003C\/p\u003E\n\u003Cp id=\u0022p-15\u0022\u003E(A) \u2265 10% weight loss was associated with AF-free survival (HR, 5.7; 95% CI, 3.3 to 10.1; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001).\u003C\/p\u003E\n\u003Cp id=\u0022p-16\u0022\u003E(B) \u0026gt; 5% weight fluctuation was associated with AF recurrence (HR, 2.2; 95% CI, 1.1 to 4.2; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001).\u003C\/p\u003E\n\u003Cp id=\u0022p-17\u0022\u003EReproduced with permission from RK Pathak, MBBS.\u003C\/p\u003E\n\u003Cp id=\u0022p-18\u0022\u003ESource: Pathak RK et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E. 2015.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-19\u0022\u003EIn regard to structural remodeling, there were greater reductions in left atrial volume and LV thickness as compared with baseline with more weight loss.\u003C\/p\u003E\n\u003Cp id=\u0022p-20\u0022\u003EThe LEGACY trial showed that sustained weight loss in obese patients appeared to improve AF burden and heart rhythm control, although weight fluctuations of \u0026gt;\u20055% reduced this benefit. The study also showed that a dedicated weight loss clinic improved patient engagement, promoted treatment adherence, and prevented regaining weight and weight fluctuations.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/5\/19.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlp62\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlp62\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}