CLINICAL STATUS AND BURDEN OF ATRIAL FIBRILLATION IN OBESE INDIVIDUALS: ASSESSING THE EFFECTSOF BODY WEIGHT CONTROL PROGRAMS
Background. Correction of modifiable risk factors is the most promising direction of modern scientific research in the field of atrial fibrillation. Aim. To assess the impact of primary obesity and the implementation of weight loss programs on the burden of atrial fibrillation. Material and methods. The study involved 162 patients with paroxysmal or persistent atrial fibrillation. Study design: prospective cohort study. Patients were divided into two groups based on body weight at the moment of study inclusion: patients with normal body mass index and patients with 1-3degree obesity. Control medical examinations were performed at least once every 2 months for at least 36 months. Based on the clinical picture of the disease and data of Holter electrocardiogram monitoring for 7 days, which was performed when the patients presented complaints, or routinely every 6 months, changes in the form of the disease were registered. Results and discussion. Throughout the study, different dynamics of body weight were observed in the patient groups. Regression of atrial fibrillation from persistent to paroxysmal form, as well as spontaneous recovery of sinus rhythm against the background of modification of other risk factors were registered in all groups, except for the group of patients with obesity and body weight increase by 3% or more during the study, and were significantly more common among patients who kept initial normal weight or reduced it with obesity by 3% or more by the end of the study. In addition, greater need and frequency of interventional treatment was demonstrated in the group of obese patients who increased their body weight by 3% or more compared with the group of obese patients who decreased their body weight by 3% or more throughout the study [( p =0,0079*) and ( p =0,0374*), respectively)]. Conclusion. The present study demonstrates the effect of primary obesity and body weight dynamics on the burden of atrial fibrillation. Obesity is directly associated with a higher percentage of persistent atrial fibrillation despite correction of other significant risk factors. Body weight reduction in obese patients not only slows down the natural progression of atrial fibrillation and reduces the severity of its symptoms, but is also a significant predictor of the regression of the disease in terms of both the form of arrhythmia (transformation of persistent atrial fibrillation into paroxysmal) and the spontaneous recovery of sinus rhythm. Reduction of body weight by 3% or more in obese patients leads to increased efficiency and efficacy of interventional treatment.