A structured lifestyle and risk factor management programme can significantly improve freedom from arrhythmia recurrence at 12 months for patients undergoing a first-time catheter ablation for atrial fibrillation (AF), according to the results of the ARREST-AF trial.¹˒²

While observational studies have previously suggested a link between risk factor modification and better ablation outcomes, this study provides randomised clinical trial evidence supporting an aggressive, comprehensive management strategy alongside procedural intervention.

ARREST-AF was an open-label, multicentre, randomised clinical trial conducted in South Australia. The study enrolled 122 consecutive patients with nonpermanent symptomatic AF who were scheduled for their first catheter ablation. To be included, patients had to have a body mass index (BMI) of 27 or greater and at least one additional cardiometabolic risk factor.¹

Participants were randomised on a 1:1 basis to either a lifestyle and risk factor management (LRFM) group or a usual care (UC) group. The LRFM group received treatment in a structured, physician-led clinic tailored to reduce modifiable risk factors. The UC group received information on risk factor management from their treating physician but was not enrolled in the dedicated clinic. Both groups underwent pulmonary vein isolation. The primary outcome was the proportion of patients free from AF in the 12-month period following ablation.¹

At 12 months post-ablation, a significantly greater proportion of patients in the LRFM group achieved the primary endpoint of arrhythmia freedom compared to the UC group (61.3% vs 40.0%; P=0.03). The hazard for recurrent arrhythmia over the follow-up period was almost halved in the intervention group (HR 0.53; 95% CI, 0.32-0.89).¹

Patients in the LRFM group also experienced a significant improvement in AF symptom severity. Furthermore, they achieved a substantially improved risk factor profile, with a mean difference in body weight reduction of –9.0 kg and a systolic blood pressure reduction of –10.8 mm Hg compared to the UC group.¹

The findings from ARREST-AF demonstrate that for patients with AF, an elevated BMI, and other cardiometabolic risk factors, an aggressive and structured risk factor management programme significantly reduces arrhythmia recurrence after catheter ablation. This underscores the importance of addressing the underlying drivers of AF, viewing it not just as a rhythm disorder to be treated procedurally, but as a systemic condition that benefits from comprehensive lifestyle modification. These results support the integration of dedicated risk factor management clinics into the standard care pathway for patients undergoing AF ablation to improve the maintenance of sinus rhythm long-term.

References

1. Pathak RK, Elliott AD, Lau DH, et al. Aggressive Risk Factor Reduction Study for Atrial Fibrillation Implications for Ablation Outcomes: The ARREST-AF Randomized Clinical Trial. JAMA Cardiol. Published online October 29, 2025. https://doi.org/10.1001/jamacardio.2025.4007

2. Mandrola JM. Oct 31, 2025 This Week in Cardiology Podcast. Medscape. October 31, 2025. https://www.medscape.com/viewarticle/1003071

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