Lifestyle modification in atrial fibrillation: Mechanisms, phenotypes and ablation outcomes

Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia and is associated with significant morbidity, mortality and healthcare utilization. Catheter ablation is increasingly used as a rhythm-control intervention for patients with symptomatic paroxysmal and persistent AF, yet recurrence rates remain suboptimal. This finding can be partly explained due to the rising prevalence of AF risk factors, such as obesity, sedentary lifestyle, sleep apnoea, diabetes, hypertension and other modifiable lifestyle-related contributors. Many of these drivers are potentially reversible, and growing evidence indicates that addressing them can improve post-ablation outcomes. The incorporation of lifestyle and risk factor management into a structured, protocol-driven, multidisciplinary AF care programme may maximize these benefits. This review underscores the interplay between modifiable lifestyle risk factors and post-ablation outcomes, explores the underlying mechanistic pathways and phenotypes, and evaluates the impact of lifestyle interventions. In addition, it provides practical guidance on peri-ablation strategies and discusses the role of imaging and digital tools. Key implications for clinical practice, existing knowledge gaps and directions for future research are also discussed.