J Am Coll Cardiol

Catheter ablation outperforms lifestyle modification plus antiarrhythmic drugs for afib in patients with obesity

July 31, 2025

Study details: The PRAGUE-25 trial was a multicenter, randomized, noninferiority study enrolling 212 patients (mean age, 60 yrs; 32% female; BMI, 34.9 kg/m²) with symptomatic paroxysmal or persistent afib and obesity (BMI 30–40 kg/m²). Patients were randomized 1:1 to either catheter ablation (CA) or a structured lifestyle modification program targeting weight loss and increased physical activity, combined with antiarrhythmic drugs (LFM+AADs). Primary endpoint: freedom from afib (no episode >30s) at 12 months post-randomization, assessed by 7-day Holter monitoring every 3 months. Secondary endpoints: afib burden, cardiorespiratory fitness, metabolic parameters, and quality of life.

Results: At 12 months, afib freedom was significantly higher in the CA group compared with the LFM+AAD group (73% vs. 34.6%; P=0.99 for noninferiority; P<0.001 for superiority). While CA demonstrated superior rhythm control, LFM+AAD led to greater weight loss (−6.4 vs. −0.35 kg; P<0.001) and improved glycemic markers, including reduced HbA1c.

Clinical impact: Although LFM+AAD yielded meaningful metabolic benefits, CA offered significantly greater efficacy in maintaining sinus rhythm over one year in patients with afib and obesity.

Source:

Osmancik P, et al. (2025, July 8). J Am Coll Cardiol. Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE-25 Trial. https://pubmed.ncbi.nlm.nih.gov/40602939/