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

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

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Video Transcription

Video Summary

In this Heart Rhythm Society podcast episode, Dr. Dinesh Gaila discusses the PROC-25 randomized trial comparing catheter ablation versus lifestyle modification with antiarrhythmic drugs in obese patients (BMI >35) with atrial fibrillation (AF). Professors Prashant Sanders and Radhika Prakash highlight that catheter ablation was superior in preventing recurrent AF episodes (73% vs. 35% freedom from arrhythmia), but both groups showed similar symptom improvement and quality of life scores. The lifestyle group achieved modest weight loss (6% vs. 10% target) and cardiovascular benefits, though challenges remain in effective risk factor management. The trial’s 12-month follow-up and 30-second AF recurrence as the primary endpoint may limit broader interpretation, with suggestions to focus on AF burden and symptoms in future studies. Experts emphasize integrating risk factor modification with ablation tailored to patient needs, acknowledging the importance of comprehensive management for long-term cardiovascular health in AF patients with obesity.

Keywords

PROC-25 trial

catheter ablation

lifestyle modification

atrial fibrillation

obesity management