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Cardiac rehabilitation after catheter ablation of atrial fibrillation in patients with left ventricular dysfunction

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Abstract

Few studies have examined the efficacy and safety of cardiac rehabilitation in patients with atrial fibrillation (AF) who underwent AF ablation. We explored the feasibility of additional cardiac rehabilitation after AF ablation in patients with a reduced left ventricular ejection fraction (LVEF). Fifty-four patients with heart failure (HF) and a reduced LVEF (HFrEF) (LVEF < 50%; 67.1 ± 11.6 years; 43 men) who underwent initial AF ablation procedures were included. Fourteen (25.9%) patients underwent cardiac rehabilitation (rehabilitation-group) and the remaining 40 (74.1%) did not (non-rehabilitation-group) after the procedure. The rehabilitation-group patients were relatively older, more likely female (p = 0.024), and had more likely a history of an HF hospitalization (p < 0.01) and cardiac device implantation (p = 0.041). The baseline LVEF was significantly lower (p = 0.043) and brain natriuretic peptide (BNP) (p < 0.01) and C-reactive protein (CRP) (p < 0.01) values were significantly higher in the rehabilitation-group. The 6-min walk distance significantly improved after 21.4 ± 11.5 days of cardiac rehabilitation during hospitalization (226.1 ± 155.9 vs. 398.1 ± 77.5 m, p = 0.016) without any adverse events. During an 18.9 ± 6.3 month follow-up period, the freedom from AF recurrence (p = 0.52) and re-hospitalizations due to HF (p = 0.63) were similar between the 2 groups. No death or strokes were observed. During the follow-up period, the LVEF significantly improved similarly in both groups, and the change in the BNP and CRP values significantly decreased in the rehabilitation-group. Despite the rehabilitation-group patients having a more severe HF status, the clinical outcomes and AF freedom were similar between the 2 groups, suggesting the favorable impact of cardiac rehabilitation after AF ablation in HFrEF patients.

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Abbreviations

ACEI:

Angiotensin-converting-enzyme inhibitor

AF:

Atrial fibrillation

ARB:

Angiotensin 2 receptor blocker

BNP:

Brain natriuretic peptide

CFAEs:

Continuous fractionated atrial electrograms

CI:

Confidence interval

CRP:

C-reactive protein

hs-TnT:

High-sensitive troponin T

HF:

Heart failure

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

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Acknowledgements

We would like to thank Mr. John Martin for his help in the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan

    Daisetsu Aoyama, Shinsuke Miyazaki, Kanae Hasegawa, Moeko Nagao, Shota Kakehashi, Moe Mukai, Takayuki Sekihara, Minoru Nodera, Tomoya Eguchi, Takayoshi Aiki, Junya Yamaguchi, Yuichiro Shiomi, Naoto Tama, Hiroyuki Ikeda, Kentaro Ishida, Hiroyasu Uzui & Hiroshi Tada

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  1. Daisetsu Aoyama
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  2. Shinsuke Miyazaki
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Corresponding author

Correspondence to Daisetsu Aoyama.

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Conflict of interest

Hiroshi Tada received honoraria (lecture fees) from Daiichi-Sankyo Co., Ltd., Biotronik Japan, Inc., Bristol-Myers Squibb, and Boehringer Ingelheim. Shinsuke Miyazaki received honoraria (lecture fees) from Daiichi-Sankyo Co., Ltd., Medtronic Japan, Co., Ltd., Bristol-Myers Squibb, and Boehringer Ingelheim. The other authors have no conflicts of interest to disclose.

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Aoyama, D., Miyazaki, S., Hasegawa, K. et al. Cardiac rehabilitation after catheter ablation of atrial fibrillation in patients with left ventricular dysfunction. Heart Vessels 36, 1542–1550 (2021). https://doi.org/10.1007/s00380-021-01829-8

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