A cardiac rehabilitation and those effects using cardiopulmonary exercise testing in patients undergoing catheter ablation for atrial fibrillation

Abstract

Abstract Background Patients with atrial fibrillation (AF) are more likely to have impaired social and physical function, impaired general health and mental and reduced quality of life and exercise tolerance (ET). From the AHA guideline, the indications of cardiac rehabilitation (CR) are for the patients with heart failure, coronary artery disease including coronary artery bypass graft surgery and percutaneous coronary intervention, after valve replacement, a pacemaker or implantable cardioverter defibrillator, however, the patients undergoing catheter ablation (CA) for AF is not included. Purpose The relationships between burden of AF and ET, and CR and those effects in patients undergoing CA for AF are unclear. Methods To evaluate ET, exercise intensity (METs) and oxygen consumption (VO2/W) at peak and anaerobic threshold (AT) points were measured using cardiopulmonary exercise testing (CPX) at 3 and 12 months later after the ablation procedure. Results This study included 50 consecutive patients (mean age: 68±12 y.o.) undergoing 1st ablation procedure for paroxysmal (PAF: n=28) or persistent AF (PEF: n=22), and all patients kept sinus rhythm after the procedure. Before ablation and after ablation 3 months later, value of exercise intensity and oxygen consumption were significantly lower in PEF patients at AT point ([Before] PAF vs. PEF = 3.3±0.7vs. 2.8±0.6 METs, p=0.02, 12.0±2.6 vs. 9.8±2.1 ml/kg/min, p=0.01, [3 months later] PAF vs. PEF = 3.7±0.9vs. 3.1±0.7 METs, p=0.04, 13.0±3.4 vs. 10.4±3.1 ml/kg/min, p=0.03, Figure 1). However, there were no significant differences between 2 groups at 12 months later. On the other hand, twenty patients received CR at hospital for 3 months (group-R) and 30 patients were recommended exercise at home (group-E). Interestingly, at 12 months after the ablation procedure, the value of exercise intensity at AT point was improved in 100% of patient in group-R versus those of 68% in group-E (+0.5±0.4 vs. +0.3±0.6 METS, p=0.02), and value of oxygen consumption at AT point was also improved in 100% of patient in group-R versus those of 68% in group-E (+2.4±2.4 vs. +1.3±3.0 ml/kg/min, p=0.02) (Figure 2). Conclusion This study demonstrates that AF is associated with ET and CA is effective for the improvement of their capacity. In patients with PEF, ET recovers close to PAF patients at 12 months. In addition, a CR is effective for further improvement of their capacity of ET in patients undergoing CA for AF.Figure 1Figure 2