Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE-25 Trial

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00064173%3A_____%2F25%3A43928592" target="_blank" >RIV/00064173:_____/25:43928592 - isvavai.cz</a>

Alternative codes found

RIV/00216224:14110/25:00141727 RIV/00216208:11110/25:10499174 RIV/00216208:11120/25:43928592 RIV/27283933:_____/25:N0000023 RIV/00064165:_____/25:10499174

Result on the web

<a href="https://doi.org/10.1016/j.jacc.2025.04.042" target="_blank" >https://doi.org/10.1016/j.jacc.2025.04.042</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1016/j.jacc.2025.04.042" target="_blank" >10.1016/j.jacc.2025.04.042</a>

Result language

angličtina

Original language name

Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE-25 Trial

Original language description

Background: Obesity is an important risk factor for atrial fibrillation (AF). Nonrandomized studies have shown that weight loss and increased physical activity are associated with AF reduction. Objectives: The goal of this study was to assess whether treatment based on lifestyle modification (LFM; directed weight loss and physical exercise) in combination with antiarrhythmic drugs (AADs) is noninferior to catheter ablation (CA) in patients with AF and obesity. Methods: In a randomized multicenter noninferiority trial, we enrolled patients with paroxysmal or persistent AF and a body mass index (BMI) of 30-40 kg/m2. Patients were randomized to the CA vs LFM+AAD groups in a 1:1 ratio. Seven-day electrocardiographic Holter recordings were performed every 3 months. The primary endpoint was AF freedom during the 12 months after randomization (ie, absence of any AF episode lasting &gt;30 s; the blanking period was 3 months). Secondary endpoints included AF burden, peak oxygen uptake during cardiopulmonary exercise testing, changes in metabolic parameters, and quality of life as assessed with the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire, all compared between randomization and 12 months. Results: A total of 212 patients were enrolled and randomized. Nine patients withdrew consent, leaving 203 patients for the final analysis; 100 patients were allocated to the CA group and 103 to the LFM+AAD group (overall age 60 +- 9 years, 31.5% female, BMI 34.9 +- 3.0 kg/m2, 55.7% with paroxysmal AF); the mean follow-up time was 23.5 months. The percentage of patients with AF freedom at 12 months was 73.0% (95% CI: 64.3%-81.7%) in the CA group and 34.6% (95% CI: 25.3%-43.9%) in the LFM+AAD group (Pnoninferiority = 0.99, Psuperiority &lt;0.001). Weight change (MINUS SIGN 6.4 +- 7.9 kg vs MINUS SIGN 0.35 +- 4.8 kg; P &lt; 0.001) and decreased HbA1c, were more significant in the LFM+AAD group than in the CA group. Conclusions: Despite important metabolic improvements associated with LFM, CA was superior to LFM combined with AADs in improving freedom from AF at 1 year in patients with AF and obesity.

Czech name

—

Czech description

—

Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30201 - Cardiac and Cardiovascular systems

Project

<a href="/en/project/NU21-02-00388" target="_blank" >NU21-02-00388: Catheter Ablation vs. Risk Factor Modification</a><br>

Continuities

P - Projekt vyzkumu a vyvoje financovany z verejnych zdroju (s odkazem do CEP)

Publication year

2025

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Journal of the American College of Cardiology

ISSN

0735-1097

e-ISSN

1558-3597

Volume of the periodical

86

Issue of the periodical within the volume

1

Country of publishing house

US - UNITED STATES

Number of pages

11

Pages from-to

18-28

UT code for WoS article

001531490200001

EID of the result in the Scopus database

2-s2.0-105008576500