by Steve S. Ryan, PhD, September 2014
Even though North America is a land of immigrants, the prevalence of A-Fib is much greater in the US than in our ancestral countries. There is ten-times more A-Fib in North America than, for example, in Asia. But once these Asians immigrate to the US, the incidence of A-Fib closely approximates that of other Americans.
Whatever protective effect Asians enjoyed in their native countries is lost when they immigrate. And the A-Fib epidemic is occurring not just in the US but also in most developed countries around the world.
A-FIB HAS INCREASED 71% IN THE LAST 20 YEARS
Dr. John D. Day of Intermountain Healthcare in Utah has performed more than 3,000 A-Fib ablation procedures. But he asks, “Am I even making a dent in this disease? I cannot remember seeing so many new patients, even young patients, with atrial fibrillation when I began my cardiology fellowship nearly 20 years ago.”
A-Fib has increased 71% in the last 20 years. The general consensus is we are seeing more A-Fib due to our aging population (and also because we are looking more for A-Fib and have better tools to diagnose it).
But that doesn’t explain why A-Fib is increasing more than our aging population.
Though he poses it as a question, Dr. Day suggests strongly that obesity is causing the increase in A-Fib. “Could the lifestyle of modern civilization and our obesity epidemic explain the marked spike in new atrial fibrillation cases we are now seeing?”
WEIGHT LOSS CAN REVERSE A-FIB
In a study at the Mayo Clinic, bariatric surgery helped to prevent A-Fib in patients with morbid obesity. New onset A-Fib occurred in only 6.4% of patients with bariatric surgery, compared to 16.1% in the control group.
Dr. Day described a new program (DARE—Drive Atrial fibrillation into Remission Evaluation) started at Intermountain Healthcare in January, 2014, to encourage aggressive lifestyle modification.
Even though less than 5% of people successfully change their lifestyle to maintain long-term weight loss, 92% of his patients are still actively engaged in this lifestyle modification program.
They’ve lost an average of 16 pounds over the last few months and a 42% reduction in their A-Fib symptom burden. They “feel better than they have ever felt before.” Patients who had failed multiple ablations were now A-Fib free.
A-Fib can be prevented or reversed by lifestyle changes. Dr. Day encourages doctors to take a holistic approach, to not just treat A-Fib but to help patients become aware of and overcome the toxic lifestyles of our culture. “A large percentage of cases in the USA are unnecessary.”
Weight loss improves A-Fib ablation success & symptoms
Researchers in Australia found that obese patients who had a catheter ablation and then lost weight, had nearly a five-fold greater probability of staying A-Fib free.
Two groups of obese patients had catheter ablations for A-Fib. The first group agreed to participate in an aggressive risk factor management program. Each group was monitored for two years. The life-style change weight management group experienced more weight loss, better systolic blood pressure, better glycemic control and lipid profile.
Ablation success rate much better with weight control
The single procedure A-Fib free rate was greater for the weight management group (32.9% vs 9.7%), while the multiple procedure results were markedly better (87% vs 17.8%). [A 32.9% success rate is relatively low compared to other centers.] A-Fib frequency, duration, severity, and symptom severity were better in the aggressive risk factor management group.
A previous study had found that a weight management program for highly symptomatic A-Fib patients reduced symptom burden and severity and reduced antiarrhythmic drug use. The authors wrote that these benefits, “may be attributable to a decrease in left atrial area and ventricular wall thickness, thereby reducing the left atrial hypertension that is a common finding in obese patients.”
The authors concluded that current A-Fib management guidelines should be changed to include risk management when treating A-Fib.
Before this study, many doctors were already requiring that A-Fib patients with pre-existing conditions or risk factors get these taken care of before getting a catheter ablation. If they didn’t, they were much more likely to have a recurrence than other patients. These Australian researchers also developed risk factor management strategies not only for weight, but also for hypertension, diabetes, sleep apnea, cholesterol, alcohol use and smoking.
Catheter Ablation often isn’t enough if pre-existing health problem
The beauty of this Australian research is it confirms scientifically what we already knew, that just performing a catheter ablation on someone with a pre-existing health problem like obesity, isn’t enough. Doctors must take a holistic approach and treat not just the A-Fib, but also the pre-existing health condition that caused or triggered the A-Fib in the first place. Let’s take the example of an obese patient who has a catheter ablation and is A-Fib free. That person’s PVs are isolated. But the ongoing obesity (which produces left atrial hypertension) can potentially trigger other areas of the heart to produce A-Fib signals.
Many doctors today emphasize a holistic approach. For example, new patients with A-Fib are routinely tested for sleep apnea. The EP works with other doctors in his practice to develop a sleep apnea strategy for this patient. The patient isn’t given a catheter ablation till they address their sleep apnea problem.
For more about a taking a more holistic approach, see our FAQs: Natural Therapies & Holistic Treatments
Last updated: Sunday, February 15, 2015