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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\u003EAtrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is associated with significant morbidity, mortality, and health care expenditures. Prevention of AF is of major public health importance; however, up to 58% of the risk factors for AF are currently unknown. Therefore, the prevention of AF is critical. This article discusses the role of exercise in AF, the effect of supplements on AF, role of the treatment of sleep apnea in the prevention of AF, as well as cultures lifestyle and psychosocial interventions.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESleep Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESleep Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EExclusive Article - For home page\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAtrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is associated with significant morbidity, mortality, and health care expenditures. Prevention of AF is of major public health importance; however, up to 58% of the risk factors for AF are currently unknown. Therefore, the prevention of AF is critical. Christine M. Albert, MD, MPH, Brigham and Women\u0027s Hospital, Boston, Massachusetts, USA, discussed the role of exercise in AF.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAlthough moderate physical exercise is associated with broad health benefits, more vigorous exercise may predispose individuals to AF. A meta-analysis demonstrated that patients who regularly perform vigorous exercise, including marathon runners and cyclists, had an increased risk for AF, with odds ratios ranging from 2.86 to 14.38 [Abdulla J, Nielsen JR. \u003Cem\u003EEuropace\u003C\/em\u003E 2009]. A longitudinal study of a large cohort of cross-country skiers showed that not only do these athletes have an increased risk of developing AF, but their risk also increased in a \u201cdose-response\u201d manner\u2014for example, with the number of races in which they participated per year and their performance [Andersen K et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe mechanism for the increased risk of AF in athletes has been speculated to be increased atrial pressure and atrial dilatation as well as shorter refractory periods. In a study based on echocardiograms performed before, immediately following, and 2 weeks after a race, researchers found that the right ventricle (RV) dilates more than the left ventricle (LV), resulting in a higher RV volume with a lower systolic volume [La Gerche A et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012]. These changes were associated with gadolinium enhancement in the interventricular septum on cardiac magnetic resonance imaging in 12.8% of patients. By 2 weeks after the race, these changes returned to near baseline (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). In addition, troponin and N-terminal pro-brain natriuretic peptide levels were elevated in the athletes, which corresponded with RV dysfunction. Interestingly, the change from baseline was greatest in patients whose sport required more endurance.\u003C\/p\u003E\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\/14\/9\/6\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Changes in RV in Endurance Athletes During a Competitive Event\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-533220758\u0022 data-figure-caption=\u0022Changes in RV in Endurance Athletes During a Competitive Event\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\/14\/9\/6\/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\/14\/9\/6\/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\/14\/9\/6\/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\/15933\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 attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EChanges in RV in Endurance Athletes During a Competitive Event\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EFAC=fractional area change; RV=right ventricle\/ventricular; SR=strain rate.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Gerche A et al. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012;33:998\u20131006. With permission from Oxford University Press.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EIn the nonathlete, data from the Physicians\u0027 Health Study did not show a significant increase in AF risk in men who habitually performed vigorous exercise when body mass index (BMI) and blood pressure were not taken into account [Aizer A et al. \u003Cem\u003EAm J Cardiol\u003C\/em\u003E 2009]. However, men who went jogging showed an increased risk of developing AF that was associated with frequency of jogging per week (trend p\u0026lt;0.01). Dr. Albert concluded by stating that risk of AF appears to be associated with long-term vigorous exercise\u2014particularly, endurance sports. However, moderate exercise reduces the risk of AF, likely as a result of lowering BMI.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ET. Jared Bunch, MD, Intermountain Medical Center, Salt Lake City, Utah, USA, discussed the effect of supplements on AF. Many patients with AF take supplements. Importantly, 9 of the 10 most commonly used supplements decrease international normalized ratio (coenzyme Q10, multiherbs, soy) or increase it (glucosamine, chondroitin, essential fatty acids, melatonin, cranberry, antioxidants). In addition, patients who take supplements are more likely to be noncompliant with warfarin and typically are not aware of warfarin-supplement interactions [Smith MB et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2009 (abstr 1116)]. Furthermore, \u223c60% of patients taking warfarin for AF used vitamins\u2014with multivitamin products, vitamin C, vitamin D, and vitamin E the most common [Smith MB et al. \u003Cem\u003ECardiology\u003C\/em\u003E 2010]. Dr. Bunch pointed out that these data indicate that physicians need to educate their patients about supplement and vitamin use.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EData from the Framingham Heart Study showed that caffeine intake was not associated with AF, even when patients regularly consumed up to 1000 mg\/d [Frost L, Vestergaard P. \u003Cem\u003EAm J Clin Nutr\u003C\/em\u003E 2005]. Other dietary factors not associated with increased risk of AF were fiber, fish intake, and alcohol consumption, as well as energy drinks; however, energy drinks did result in a prolonged QT interval [Shah SA et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2013 (abstr P324)]. In addition, serum vitamin D levels above 100 were associated with increased risk of AF (HR, 2.51; p=0.003) [Smith MB et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2011 (abstr 14699)].\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EIn a randomized placebo-controlled study of patients who supplemented with eicosapentaenoic and docosahexaenoic acids (omega-3 fatty acid fish oil antioxidants; 1:2 ratio), vitamin C (1 g\/day), and vitamin E (400 IU\/day) before on-pump cardiac surgery, patients who supplemented had a significantly higher rate of event-free survival compared with the placebo group (log-rank p\u0026lt;0.001; \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) [Rodrigo R et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2013]. However, a randomized placebo-controlled study of omega-3 fatty acid supplementation demonstrated no effect on survival-free recurrence of AF [Macchia A et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2013].\u003C\/p\u003E\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\/14\/9\/6\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Effect of Antioxidant Supplementation on Atrial Fibrillation Occurrence\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-533220758\u0022 data-figure-caption=\u0022Effect of Antioxidant Supplementation on Atrial Fibrillation Occurrence\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\/14\/9\/6\/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\/14\/9\/6\/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\/14\/9\/6\/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\/15935\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 attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EEffect of Antioxidant Supplementation on Atrial Fibrillation Occurrence\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EPOAF=postoperative atrial fibrillation.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReproduced from Roidrigo R et al. A randomized controlled trial to prevent post-operative atrial fibrillation by antioxidant reinforcement. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2013;62:1457\u20131465. With permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003ESumeet S. Chugh, MD, Cedars-Sinai Medical Center, Los Angeles, California, USA, presented the role of the treatment of sleep apnea in the prevention of AF. Observational studies have suggested that there is an association between obstructive sleep apnea (OSA) and AF. In one study, 49% of cardiology patients with AF had OSA, compared with 32% of patients without AF (p=0.0004); the OR was 2.19 (95% CI, 1.40\u20133.42; p=0.0006) after adjustment for BMI, neck circumference, hypertension, and diabetes mellitus [Gami AS et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2004]. In addition, researchers of a retrospective cohort study of more than 3500 patients found that over a median 4.7 years of follow-up, the frequency of AF was greatest in patients with OSA compared with patients without OSA [Gami AS et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2007]. Another study revealed that as hypoxemia increased in patients with OSA, so did risk of AF [Tanigawa T et al. \u003Cem\u003EHeart\u003C\/em\u003E 2006]. However, some studies have found no association between OSA and AF and between age-, sex-, and cardiovascular morbidity-matched AF cases and controls [Porthan KM. \u003Cem\u003EChest\u003C\/em\u003E 2004].\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EYet, in a study of patients who experienced an acute episode of AF, treatment of diagnosed OSA with continuous positive airway pressure (CPAP) resulted in no significant difference in reductions in AF recurrence compared with control patients and patients with untreated OSA [Kanagala R et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2003]. A recent study showed that treatment of OSA with CPAP reduced the risk of AF recurrence in patients who underwent catheter ablation, similar to that of patients without OSA (\u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 3\u003C\/a\u003E). For patients who underwent pulmonary vein isolation (PVI) and had OSA, their risk of recurrence was lower if they used CPAP than if they did not use it. In fact, if they underwent PVI and used CPAP, their risk was similar to that of patients without OSA. Patients with OSA who underwent catheter ablation and did not receive CPAP treatment had similar rates of AF recurrence as patients with OSA who did not undergo catheter ablation [Fein AS et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cdiv id=\u0022F3\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\/14\/9\/6\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Effect of CPAP Treatment of OSA on AF-Free Survival\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-533220758\u0022 data-figure-caption=\u0022Effect of CPAP Treatment of OSA on AF-Free Survival\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 3.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/9\/6\/F3.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\/14\/9\/6\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 3.\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\/14\/9\/6\/F3.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\/15936\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 attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 3.\u003C\/span\u003E \n            \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003EEffect of CPAP Treatment of OSA on AF-Free Survival\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-5\u0022\u003EAF=atrial fibrillation; CPAP=continuous positive airway pressure; OSA=obstructive sleep apnea; PVI=pulmonary vein isolation.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-6\u0022\u003EReproduced from Fein AS et al. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2013;62:300\u2013305. With permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-14\u0022\u003EJohn D. Day, MD, Intermountain Medical Center, Salt Lake City, Utah, USA, discussed cultures lifestyle and psychosocial interventions. A recent study of 438 patients with a BMI \u226543 showed that after 7.2 years, AF occurrence was significantly lower in patients who underwent bariatric surgery (6.4%) compared with those who did not undergo surgery (16.1%; p\u0026lt;0.01) [Cha YM et al. HRS 2014 (abstr PO01\u2013187)]. This was about a 4-fold increase in prevalence of AF in patients who did not undergo bariatric surgery. Dr. Day highlighted that this study suggests that AF is not a \u201clife sentence\u201d but is reversible. A trial of 150 patients with a BMI \u0026gt;27 who had symptomatic AF were randomly assigned to receive weight loss advice or participate in a weight loss program and were followed for 15 months. Patients who participated in the program lost an average of 32 pounds, whereas patients who received advice lost an average of 8 pounds [Abed HS et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2013]. Similarly, patients who participated in the program had a greater reduction in AF symptoms, C-reactive protein levels, blood pressure, lipids, insulin and glucose levels, and left atrial size (\u003Ca id=\u0022xref-fig-4-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F4\u0022\u003EFigure 4\u003C\/a\u003E). Dr. Day pointed out that even the group that received advice had a decrease in AF symptoms.\u003C\/p\u003E\u003Cdiv id=\u0022F4\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\/14\/9\/6\/F4.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Atrial Fibrillation Symptoms Following Weight Loss\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-533220758\u0022 data-figure-caption=\u0022Atrial Fibrillation Symptoms Following Weight Loss\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 4.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/9\/6\/F4.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\/14\/9\/6\/F4.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 4.\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\/14\/9\/6\/F4.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\/15939\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 attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 4.\u003C\/span\u003E \n            \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003EAtrial Fibrillation Symptoms Following Weight Loss\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-7\u0022\u003EReproduced from Abed HS et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. \u003Cem\u003EJAMA\u003C\/em\u003E 2013;310:2050\u20132060. \u00a9 2013 American Medical Association. All rights reserved.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-16\u0022\u003EAlthough the prevalence of AF is rising, moderate exercise and improved diet resulting in weight loss may have a beneficial effect on the development and recurrence of AF and may decrease AF symptoms. Studies are ongoing of the mechanisms underpinning the benefit of these lifestyle changes and the potential adverse effects of intensive exercise and OSA that lead to AF. Historically taught triggers of AF, such as excessive caffeine intake, may not be as impactful as once thought.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\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\/14\/9\/6.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?nzp661\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?nzp661\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}