Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE-25 Trial.
Summary
In obese patients with AF (BMI 30–40 kg/m²), catheter ablation was superior to lifestyle modification plus antiarrhythmic drugs for achieving freedom from AF at 1 year in a randomized multicenter trial. Although the lifestyle arm improved metabolic parameters, it did not match ablation’s rhythm-control efficacy.
Key Findings
- Catheter ablation achieved superior 1-year freedom from AF versus lifestyle modification plus antiarrhythmic drugs.
- Lifestyle intervention improved metabolic health but did not match ablation’s rhythm-control efficacy.
- Randomized, multicenter design with 203 analyzed patients strengthens internal validity.
Clinical Implications
For obese AF patients, catheter ablation should be strongly considered as first-line rhythm control, while structured lifestyle modification remains essential for cardiometabolic risk reduction.
Why It Matters
This RCT addresses a rapidly growing AF subgroup—patients with obesity—providing head-to-head evidence to guide first-line rhythm strategy selection.
Limitations
- Modest sample size and 1-year follow-up limit long-term generalizability
- Open-label design may introduce performance bias
Future Directions
Longer-term follow-up and trials integrating structured weight-loss programs with ablation could define combined strategies for durable rhythm control.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Randomized controlled trial provides highest-level evidence for comparative effectiveness.
- Study Design
- OTHER