Exercise-based cardiac rehabilitation for patients with catheter ablation for persistent atrial fibrillation: A randomized controlled clinical trial

Abstract

Aims The efficacy and safety of cardiac rehabilitation for patients with persistent atrial fibrillation who restored sinus rhythm after catheter ablation remains unclear. The aim of the present study was to evaluate the effects of cardiac rehabilitation on exercise capacity, inflammatory status, cardiac function, and safety in patients with persistent atrial fibrillation who had catheter ablation. Methods In this randomized controlled study, 61 patients treated with catheter ablation for persistent atrial fibrillation (male, 80%; mean age, 66 ± 9 years) were analyzed. Thirty patients underwent cardiac rehabilitation (rehabilitation group), whereas the remaining 31 patients received usual care (usual care group). The rehabilitation group underwent endurance and resistance training with moderate intensity, at least three times per week for six months. Six-minute walk distance, muscle strength, serum high-sensitivity C-reactive protein, plasma pentraxin 3, left ventricular ejection fraction and atrial fibrillation recurrence were assessed at baseline and at six-month follow-up. Results In the rehabilitation group, significant increases in the six-minute walk distance, handgrip strength, leg strength and left ventricular ejection fraction and significant decreases in high-sensitivity C-reactive protein and plasma pentraxin 3 concentrations were observed at six-month follow-up compared with baseline (all p < 0.05). No significant changes were observed in the usual care group. During the six-month follow-up period, the number of patients with atrial fibrillation recurrence was six (21.4%) in the rehabilitation group and eight (25.8%) in the usual care group (risk ratio, 0.83; 95% confidence interval, 0.33 to 2.10). Conclusions Cardiac rehabilitation improved exercise capacity without increasing the risk for atrial fibrillation recurrence. It may also be effective in managing systemic inflammatory status and systolic left ventricular function in patients with persistent atrial fibrillation treated with catheter ablation.

Efficacy of Physical Exercise on the Quality of Life, Exercise Ability, and Cardiopulmonary Fitness of Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis

“…The 12 RCTs included 819 patients (408 allocated to experimental groups and 411 allocated to control groups). Four RCT exercise interventions were aerobic (Osbak et al, 2012 ; Malmo et al, 2016 ; Joensen et al, 2019 ; Nourmohammadi et al, 2019 ), one was anaerobic (Zeren et al, 2016 ), three were aerobic combined with anaerobic (Hegbom et al, 2007 ; Risom et al, 2016 ; Kato et al, 2019 ), one was Qigong (Pippa et al, 2007 ), and three were Yoga (Lakkireddy et al, 2013 ; Wahlstrom et al, 2017 ; Wahlström et al, 2020 ). The details of all included studies are shown in Table 2 .…”

“…The effect of physical exercise on exercise ability was measured by the 6MWT. Five RCTs (Pippa et al, 2007 ; Osbak et al, 2012 ; Zeren et al, 2016 ; Joensen et al, 2019 ; Kato et al, 2019 ) reported the results of 6MWTs, which were improved after physical exercise in AF patients (SMD = 0.69, 95%CI: 0.19–1.19; p = 0.007) ( Figure 6 ) with high heterogeneity ( I 2 = 70.6%, p = 0.009). After meta-regression analysis, the training duration was selected as the heterogeneity factor ( p = 0.047) from the possible factors (training period, training mode, training duration and exercise intensity) that may cause heterogeneity.…”

“…In the present meta-analysis, we found that (i) physical exercise had a positive effect on the QoL, exercise ability and cardiopulmonary fitness in patients with AF; (ii) the exercise mode could predict the effect of physical exercise on QoL; and (iii) the exercise duration could predict the effect of physical exercise on exercise ability. Moderate exercise is beneficial for AF patients likely because it has anti-adrenalin, anti-inflammatory, anti-ischemic, anti-arrhythmia and anti-thrombosis effects, which can reduce the risk factors of AF (Kato et al, 2019 ). Because of the limited methodological quality of the included RCTs, the evidence of the benefits of physical exercise for AF patients remains limited.…”

“…Physical exercise can effectively assist in the therapy of various types of cardiovascular diseases, and the potential benefits of moderate regular physical exercise in reducing the risk of AF are considerable (Eckel et al, 2014 ). Randomized studies of physical exercise in patients with AF found that significant improvements in QoL and exercise ability can be achieved through a short-term exercise training program (Hegbom et al, 2007 ; Osbak et al, 2012 ; Kato et al, 2019 ).…”

Symptomatic atrial fibrillation: Care should not stop after catheter ablation

“…The current issue of European Journal of Preventive Cardiology publishes an interesting study from Kato and colleagues including 61 patients who underwent catheter ablation for persistent atrial fibrillation. 6 The authors randomized patients to catheter ablation alone versus catheter ablation plus a cardiac rehabilitation programme that included endurance and resistance training at least three times per week. After six months, patients who underwent exercise training significantly improved exercise capacity compared with the control group and significantly improved their systemic inflammatory status.…”