Catheter ablation was superior to lifestyle modification plus antiarrhythmic drugs for AF freedom only in the Intermediate phenotype (88.5% vs 65.9%; OR 3.98; 95% CI 1.01-15.57; p=0.047).
RCT (n=122)
Does catheter ablation improve AF freedom compared to lifestyle modification plus antiarrhythmic drugs in different phenotypes of obese patients with atrial fibrillation?
Catheter ablation superiority over lifestyle modification and antiarrhythmic drugs in obese AF patients may be driven primarily by those with an intermediate remodeling phenotype, highlighting the need for personalized treatment approaches.
Estimación del efecto: OR 3.98 (95% CI 1.01-15.57)
Tasa de eventos absoluta: 88.5% vs 65.9%
valor p: p=0.047
Background: The PRAGUE-25 trial demonstrated catheter ablation (CA) superiority over lifestyle modification plus antiarrhythmic drugs (LFM + AAD) in obese patients with atrial fibrillation (AF). However, obese AF patients represent a heterogeneous population with varying pathophysiological substrates. We hypothesized that distinct patient phenotypes may exhibit differential treatment responses. Methods: This post-hoc analysis applied hierarchical cluster analysis (Ward's D2 method, Euclidean distance) to 122 PRAGUE-25 patients with complete data using six delta (12-month minus baseline) echocardiographic and metabolic variables (Δ-LAVI, Δ-LVEDD, Δ-NT-proBNP, Δ-triglycerides, Δ-leukocytes, Δ-platelets). Treatment effects within each phenotype were compared using Fisher's exact test and odds ratios with 95% confidence intervals. Results: = 3.45, p = 0.178), CA superiority was statistically significant only in the Intermediate phenotype (OR 3.98, 95% CI: 1.01-15.57, p = 0.047; AF freedom 88.5% CA vs 65.9% LFM + AAD). In the Metabolic and Advanced Neurohormonal/Inflammatory phenotypes (45% of patients), no statistically significant treatment difference was observed; however, wide confidence intervals preclude conclusions of treatment equivalence in these underpowered subgroups. These findings appear to be primarily driven by the Intermediate Remodeling phenotype. Conclusions: These hypothesis-generating findings suggest phenotype-dependent treatment response heterogeneity in obese atrial fibrillation. As cluster membership can only be determined retrospectively, prospective validation using baseline predictor models is required before clinical application.
Ranič et al. (Sun,) conducted a rct in Obese atrial fibrillation (n=122). Catheter ablation vs. Lifestyle modification plus antiarrhythmic drugs (LFM + AAD) was evaluated on AF freedom (OR 3.98, 95% CI 1.01-15.57, p=0.047). Catheter ablation was superior to lifestyle modification plus antiarrhythmic drugs for AF freedom only in the Intermediate phenotype (88.5% vs 65.9%; OR 3.98; 95% CI 1.01-15.57; p=0.047).