Improving A-fib outcomes by losing weight

My cardiologist mentioned that a study had found that patients who lost 10% of their body weight as they were treated for A-fib did better.

I looked up one of the studies where this 10% weight loss = improved A-fib outlook came from.

There is the LEGACY study.

All patients in this study had a BMI that classified them as overweight, or obese. The study excluded anyone who did not weigh 10% more than “normal”. The average patient in the study had a BMI that put them well into the obese range.

This chart caught my attention.



The red line depicts the outcome over time for patients who received treatment for A-fib who also lost 10% of their body weight during the study period. The dark blue line is the group who didn’t lose a significant amount of weight.

All these patients were treated with drugs and/or multiple ablations – whatever they and their physician agreed on. The difference between the three groups was how much weight they lost while being treated for A-fib.

Is there data on patients with BMI in the “normal” range, i.e. below 25? My BMI is about 25.

I was on Tenormin for 17 years before getting my first afib. I sadly became obese from the Tenormin. In 1987 I was a size 0-2 so gradually during the 17 years I gained weight (being petite in height) which was not healthy. I lost 31.2% of my body weight after my afib diagnosis by being anal and not giving up dieting. I stayed in nsr for 5 years until during one chemo my afib returned once. 4 years in nsr until my second breakthrough afib during a vomit-thon which was vagal.

I agree weight lost helps reduce afib episodes. It’s not easy to lose weight until you can visualize the end of the tunnel and be positive for baby step losses.

I’m on sotalol now which is adding weight to my size 2 (11 pounds gain) and my episodes are very frequent. I’m going to lose it by determination because I think less is best for afib.

My hypothesis is those who are metabolically unhealthy may do better by improving their metabolic status. If you are not overweight and you are fit, likely not much benefit. Exercise is in the mix too. It is a "Goldilocks" variable. If you are sedentary, then adding moderate exercise may help. If you are very fit, then that may be a trigger and backing off may help. In the latter case, adding more exercise likely would not help and might make things worse.

George-well said.

Before my successful ablation in Bordeaux I couldn’t exercise and was so miserable that I gained a lot of weight. Prof. Haïssaguerre said that it would help if I could lose 10 kilos so he obviously thought it made a difference.

I actually lost more than that, and after the ablation I continued to lose so am no longer overweight. Being free of AF meant I had my life back, could exercise again and was no longer miserable.

Gill

What strikes me about this study is how significant what the A-fib literature appears to call a "risk factor" can be. I'm trying to find out what my risk factors are.

There might be something about losing weight that leads to more successful A-fib treatment outcomes rather than being a certain weight. The average patient in the LEGACY study started with a BMI around 33. Someone 6 feet tall with a BMI of 33 would weigh around 242 lbs. If that person lost 10% of their weight and got down to 218 pounds, their BMI would then be 29 - 30, which is still borderline obese on the BMI scale.

Yet these patients, who were obese when they started the study and obese when the study ended, are the typical patients who did so much better with their A-fib treatment when compared to those who did not manage to lose any weight at all.

My cardiologist appears to think even someone who has a BMI of 25 could benefit from losing up to 10% of his body weight. I'm not as convinced, however I am going to see if I can lose something like 5%. I have a large frame - if I lost 10% there might be no fat on me at all.

The most significant risk factor for me that I believe I have discovered so far is the way I sometimes handle stress.

I know a few people who are way overweight, they don't have AF, I am slim and do all of my yard work, garden, housework, everything and I am now in permanent AF. I got AF because I was hyper thyroid, for 20 years i was perioxmyal got AF episodes occasionally and always converted until about a year and a half ago i went into AF and i am still there. I don't feel it and i just take Xarelto. I really don't think weight has much to do with getting AF, a person is more healthy and probably for some diseases it does matter like diabetes.

I seem to remember reading that obesity is a recognised risk factor for AF. I found this:

[www.ncbi.nlm.nih.gov]

Gill



Edited 3 time(s). Last edit at 12/28/2021 12:12AM by Gill.

Without question obesity is an afib risk factor. That's been demonstrated in many studies.

No, that doesn't mean if you're obese you're going to get afib, but it does mean if 100 people are obese and 100 others aren't, more of the obese people will have afib than those who aren't obese.

How many that come to this site and have AF are obese or were obese when they got AF? I believe that AF is in our DNA, my mother had AF and i think my grandmother had it as well. I have thyroid problems (Graves disease) as did my father. DNA

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David_L
My cardiologist appears to think even someone who has a BMI of 25 could benefit from losing up to 10% of his body weight. I'm not as convinced, however I am going to see if I can lose something like 5%. I have a large frame - if I lost 10% there might be no fat on me at all.

My n=1. I played football in college. At 6'0", I bulked up to 205#s. I maintained this as an adult. I was fit, doing things like the Pikes Peak Ascent race (gains 7,800' over 13.3 miles and tops out over 14,100'). My fitness was my path to afib in 2004, at age 49. I had a 2.5 month episode in the first 4 months. I created an afib remission program that included detraining, where I limited long duration exertion to what is deemed Zone 2 by cyclists, particularly the definition of Iñigo San Millan, PdD, researcher and coach of the 2020 & 2021 winning Tour de France teams (serum lactate between 1.5 & 2.0 mmol/L). More detail in this post. I also added in magnesium to bowel tolerance, potassium citrate consumed over the day & taurine. When this failed, I took flecainide on demand. I maintained good fitness, but didn't push the extremes. As I backed off exercise somewhat, my weight increased to 210# (BMI 28.5), though my body fat % was still <20%.. In 2009, I keto adapted, and over several years dropped to my weight. Today, I'm a little shorter (5'11" at age 66), and I weigh what I did in Grade 10 - 168# (BMI 23.4). My scale says my body fat is ~14.5. I remain fit and still do not do long duration, high intensity (short is ok) exercise. I do long duration at Zone 2.

In any case, dropping the weight by 20% did not improve my afib, though my control has been pretty good over the years.

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Elizabeth
I believe that AF is in our DNA, my mother had AF and i think my grandmother had it as well.

I completely agree with you that afib is probably an inherited disease. It's probably a prerequisite that you have the genes in the first place to ever develop afib. But having the genes probably doesn't guarantee afib. It's just a prerequisite But if you do have that gene and you also happen to have one of the known risk factors like obesity, diabetes, sleep apnea, hyperthyroidism, and athletic overtraining, then that can seal the deal.

Epigenetics - turning these genes on(off?) through eating/life style

funny- reading this I was thinking about a study I was approached for regarding using Metforamin in conjunction with ablation. My sugar toggles around 100. So I qualified. (usually 110 or something like that) and had an upcoming ablation. ( I got ticked off because I am taking Dofetilide and the people running the study said that was fine- yet my EP .. same institution.. said no.. but I digress). Their premise based on previous info was that matforamin helped those in afib. But it could be a thing where when people have diabetes they are also encouraged to loose weight- and it all works together. (If anyone is interested in the metformin study I can find it... I just looked it up for someone else.. I opted not to participate)