Long-term effect of goal-directed weight management in an atrial fibrillation cohort: A long-term follow-up study (LEGACY)

Rajeev K. Pathak, Melissa E. Middeldorp, Megan Meredith, Abhinav B. Mehta, Rajiv Mahajan, Christopher X. Wong, Darragh Twomey, Adrian D. Elliott, Jonathan M. Kalman, Walter P. Abhayaratna, Dennis H. Lau, Prashanthan Sanders

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692 Citations (Scopus)


Background Obesity and atrial fibrillation (AF) frequently coexist. Weight loss reduces the burden of AF, but whether this is sustained, has a dose effect, or is influenced by weight fluctuation is unknown. Objectives This study sought to evaluate the long-term impact of weight loss and weight fluctuation on rhythm control in obese individuals with AF. Methods Of 1,415 consecutive patients with AF, 825 had a body mass index ≥27 kg/m2 and were offered weight management. After screening for exclusion criteria, 355 were included in this analysis. Weight loss was categorized as group 1 (≥10%), group 2 (3% to 9%), and group 3 (<3%). Weight trend and/or fluctuation was determined by yearly follow-up. We determined the impact on the AF severity scale and 7-day ambulatory monitoring. Results There were no differences in baseline characteristics or follow-up among the groups. AF burden and symptom severity decreased more in group 1 compared with groups 2 and 3 (p < 0.001 for all). Arrhythmia-free survival with and without rhythm control strategies was greatest in group 1 compared with groups 2 and 3 (p < 0.001 for both). In multivariate analyses, weight loss and weight fluctuation were independent predictors of outcomes (p < 0.001 for both). Weight loss ≥10% resulted in a 6-fold (95% confidence interval: 3.4 to 10.3; p < 0.001) greater probability of arrhythmia-free survival compared with the other 2 groups. Weight fluctuation >5% partially offset this benefit, with a 2-fold (95% confidence interval: 1.0 to 4.3; p = 0.02) increased risk of arrhythmia recurrence. Conclusions Long-term sustained weight loss is associated with significant reduction of AF burden and maintenance of sinus rhythm.

Original languageEnglish
Pages (from-to)2159-2169
Number of pages11
JournalJournal of the American College of Cardiology
Issue number20
Publication statusPublished or Issued - 26 May 2015


  • ablation
  • atrial fibrillation
  • cardiac risk factors
  • obesity
  • outcomes
  • remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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