The Lead Episode 124: A Discussion of Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE 25 Trial, LIVE at HRX-A Discussion of Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE 25 Trial, LIVE at HRX (Bonus Video)

A Discussion of Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE 25 Trial, LIVE at HRX (Bonus Video)

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Video Summary

In this Heart Rhythm Society podcast, experts discuss the PROC-25 trial comparing catheter ablation versus lifestyle modification combined with antiarrhythmic drugs in obese atrial fibrillation (AF) patients. The randomized trial of 212 patients with a median BMI >35 found catheter ablation significantly superior in reducing recurrent atrial arrhythmia (73% vs 35%). However, AF burden and quality of life measures were similar between groups, and weight loss in the lifestyle arm was modest (6% vs target 10%). Experts highlighted that while catheter ablation better maintains sinus rhythm, risk factor modification provides cardiovascular benefits and symptom control. Limitations included short 12-month follow-up, minimal use of modern weight loss agents, and endpoint selection focusing on arrhythmia episodes rather than symptom burden. The panel emphasized that combining targeted ablation with comprehensive risk factor management tailored to patient profiles may optimize outcomes. The trial advances understanding of AF management in obesity but calls for further research on integrating lifestyle interventions and ablation strategies.

Keywords

PROC-25 trial

catheter ablation

lifestyle modification

obese atrial fibrillation

antiarrhythmic drugs