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

J 2025

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

OSMANCIK, Pavel; Tomas ROUBICEK; Stepan HAVRANEK; Jan CHOVANCIK; Veronika BULKOVA et al.

Základní údaje

Originální název

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

Autoři

Vydání

Journal of the American College of Cardiology, New York, Elsevier Science INC, 2025, 0735-1097

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30201 Cardiac and Cardiovascular systems

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 22.300 v roce 2024

Označené pro přenos do RIV

Ano

Kód RIV

RIV/00216224:14110/25:00141745

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

atrial fibrillation; catheter ablation; lifestyle modification; obesity; antiarrhythmic drug

Štítky

14119612, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 7. 8. 2025 07:43, Mgr. Tereza Miškechová

Anotace

V originále

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/m(2). 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 >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/m(2), 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 (P-noninferiority = 0.99, P-superiority <0.001). Weight change (-6.4 +/- 7.9 kg vs -0.35 +/- 4.8 kg; P < 0.001) and decreased HbA(1c), 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. (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Citovat

OSMANCIK, Pavel; Tomas ROUBICEK; Stepan HAVRANEK; Jan CHOVANCIK; Veronika BULKOVA; Dalibor HERMAN; Martin MATOULEK; Vladimir TUKA; Ivan RANIC; Jana HOZMANOVA; Marek HOZMAN; Lucie ZNOJILOVA; Adam LATINAK; Jan PIDHORODECKY; Milan DUSIK; Jan SIMEK; Otakar JIRAVSKÝ; Bogna JIRAVSKA-GODULA; Frantisek LEHAR; Michal CERNOSEK; Zuzana HEJDUKOVA; Hana ZELINKOVA; Jiří JARKOVSKÝ a Klára BENEŠOVÁ. Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation PRAGUE-25 Trial. Journal of the American College of Cardiology. New York: Elsevier Science INC, 2025, roč. 86, č. 1, s. 18-28. ISSN 0735-1097. Dostupné z: https://doi.org/10.1016/j.jacc.2025.04.042.

@article{2511277,
   author = {Osmancik, Pavel and Roubicek, Tomas and Havranek, Stepan and Chovancik, Jan and Bulkova, Veronika and Herman, Dalibor and Matoulek, Martin and Tuka, Vladimir and Ranic, Ivan and Hozmanova, Jana and Hozman, Marek and Znojilova, Lucie and Latinak, Adam and Pidhorodecky, Jan and Dusik, Milan and Simek, Jan and Jiravský, Otakar and JiravskaandGodula, Bogna and Lehar, Frantisek and Cernosek, Michal and Hejdukova, Zuzana and Zelinkova, Hana and Jarkovský, Jiří and Benešová, Klára},
   article_location = {New York},
   article_number = {1},
   doi = {https://doi.org/10.1016/j.jacc.2025.04.042},
   keywords = {atrial fibrillation; catheter ablation; lifestyle modification; obesity; antiarrhythmic drug},
   language = {eng},
   issn = {0735-1097},
   journal = {Journal of the American College of Cardiology},
   title = {Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation PRAGUE-25 Trial},
   url = {https://www.sciencedirect.com/science/article/pii/S0735109725063351?via%3Dihub},
   volume = {86},
   year = {2025}
}

TY  - JOUR
ID  - 2511277
AU  - Osmancik, Pavel - Roubicek, Tomas - Havranek, Stepan - Chovancik, Jan - Bulkova, Veronika - Herman, Dalibor - Matoulek, Martin - Tuka, Vladimir - Ranic, Ivan - Hozmanova, Jana - Hozman, Marek - Znojilova, Lucie - Latinak, Adam - Pidhorodecky, Jan - Dusik, Milan - Simek, Jan - Jiravský, Otakar - Jiravska-Godula, Bogna - Lehar, Frantisek - Cernosek, Michal - Hejdukova, Zuzana - Zelinkova, Hana - Jarkovský, Jiří - Benešová, Klára
PY  - 2025
TI  - Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation PRAGUE-25 Trial
JF  - Journal of the American College of Cardiology
VL  - 86
IS  - 1
SP  - 18-28
EP  - 18-28
PB  - Elsevier Science INC
SN  - 07351097
KW  - atrial fibrillation
KW  - catheter ablation
KW  - lifestyle modification
KW  - obesity
KW  - antiarrhythmic drug
UR  - https://www.sciencedirect.com/science/article/pii/S0735109725063351?via%3Dihub
N2  - 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/m(2). 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 >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/m(2), 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 (P-noninferiority = 0.99, P-superiority <0.001). Weight change (-6.4 +/- 7.9 kg vs -0.35 +/- 4.8 kg; P < 0.001) and decreased HbA(1c), 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. (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
ER  -

OSMANCIK, Pavel; Tomas ROUBICEK; Stepan HAVRANEK; Jan CHOVANCIK; Veronika BULKOVA; Dalibor HERMAN; Martin MATOULEK; Vladimir TUKA; Ivan RANIC; Jana HOZMANOVA; Marek HOZMAN; Lucie ZNOJILOVA; Adam LATINAK; Jan PIDHORODECKY; Milan DUSIK; Jan SIMEK; Otakar JIRAVSKÝ; Bogna JIRAVSKA-GODULA; Frantisek LEHAR; Michal CERNOSEK; Zuzana HEJDUKOVA; Hana ZELINKOVA; Jiří JARKOVSKÝ a Klára BENEŠOVÁ. Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation PRAGUE-25 Trial. \textit{Journal of the American College of Cardiology}. New York: Elsevier Science INC, 2025, roč.~86, č.~1, s.~18-28. ISSN~0735-1097. Dostupné z: https://doi.org/10.1016/j.jacc.2025.04.042.

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