Exercise-based cardiac rehabilitation for patients with atrial fibrillation receiving catheter ablation: associations with long-term clinical outcomes

Abstract Background Catheter ablation is an effective treatment for symptomatic atrial fibrillation (AF) and has superiority over drug treatments. Emerging evidence suggests that exercise-based cardiac rehabilitation (ExCR) can improve the health outcomes of people with AF, but the long-term impact of ExCR on clinical endpoints for patients with AF following catheter ablation is unclear. We investigated 12-month all-cause mortality, hospitalisation, ischaemic stroke, and myocardial infarction in patients with AF receiving catheter ablation and ExCR versus matched controls receiving catheter ablation only. Methods and Results A propensity-matched cohort study was conducted using electronic medical records from a global federated health research network. Patients with AF who received catheter ablation and ExCR were propensity-score matched for age, sex, ethnicity, comorbidities, cardiovascular procedures, and cardiovascular medication with patients with AF who received catheter ablation only. Using logistic regression, 12-month incidence of all-cause mortality, hospitalisation, ischaemic stroke, and myocardial infarction were compared. In 6510 AF patients (mean age 66, SD; 11, 26.3% female) who had received catheter ablation, ExCR was associated with lower all-cause mortality (OR 0.73; 95% CI, 0.59-0.92) and hospitalisations (OR 0.77; 95% CI, 0.69-0.85) when compared with propensity-score matched controls. No significant associations were shown for ischaemic stroke (OR 0.88; 95% CI, 0.62-1.25) or myocardial infarction (OR 0.89; 95% CI, 0.67-1.20). Secondary analysis of AF progression from paroxysmal to sustained AF at 12-month follow-up demonstrated proportionally lower AF progression with 10% in the ExCR cohort compared to 15% in the catheter ablation cohort (OR 0.62, 95% CI: 0.56- 0.68). Conclusions ExCR in patients with AF who received catheter ablation associated with lower all-cause mortality and hospitalisation at 12-month follow-up compared to those who received catheter ablation alone, as well as less AF progression from paroxysmal to sustained AF at 12-month follow-up.