Risk-factor modification to prevent recurrent atrial fibrillation after catheter ablation

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TABLE 2

Summary of evidence surrounding preablation and postablation risk-factor modification

Risk factor	Before the procedure	After the procedure
Hypertension	Hypertension increases incidence of atrial fibrillation⁵ Periprocedural renal denervation reduces blood pressure and atrial fibrillation recurrence¹² Whether aggressive hypertension management before ablation provides additional benefit in preventing atrial fibrillation recurrences is unclear¹¹	Hypertension increases postprocedural atrial fibrillation recurrence risk⁸ Rates of recurrence in patients with controlled hypertension are similar to those of patients with no hypertension⁹
Diabetes mellitus	Diabetes mellitus increases incidence of atrial fibrillation¹⁵ Periprocedural role of sodium-glucose cotransporter 2 inhibitors is unclear	Hemoglobin A1c control reduces atrial fibrillation recurrence¹⁸
Obesity	Obesity increases both incidence and severity of atrial fibrillation^29,30 Preprocedural weight management, including bariatric surgery, improves success^33–35,38
Obstructive sleep apnea		Continuous positive airway pressure reduces atrial fibrillation recurrence in patients with obstructive sleep apnea^43,44
Metabolic dysfunction–associated steatotic liver disease	Preprocedural management is beneficial⁴⁶ Role of pharmacotherapy is unclear