Impact of atrial fibrillation type on outcomes following aerobic exercise training: analysis from the ACTIVE-AF Trial

Abstract

Abstract Background The ACTIVE-AF study demonstrated that aerobic exercise prescription promotes the maintenance of sinus rhythm in patients with atrial fibrillation (AF). However, it is unclear whether these benefits are observed in patients with both paroxysmal and persistent AF. Purpose Compare efficacy of exercise intervention on arrhythmia recurrence between paroxysmal (ParAF) and persistent (PerAF) patients. Methods This study was a prospective, randomized, controlled trial of patients with symptomatic paroxysmal or persistent AF, referred for consideration of AF ablation. Randomization was 1:1 to either aerobic exercise intervention or usual medical care for a period of 6 months with a further 6 months follow-up. The exercise intervention was delivered in a hybrid format of weekly supervised exercise sessions coupled with prescribed home exercise, up to a total of 210 minutes per week. The intervention was led by a clinical exercise physiologist. Management of arrhythmia was at the discretion of a cardiologist blinded to patient randomisation. The primary endpoint reported here is recurrent AF without rhythm control strategies. Results Of the 120 patients enrolled in the study, 74 (62%) had a history of ParAF. Patients with PerAF typically had higher body mass index (32.0±6.6 versus 29.5±5.2 Kg/m2, p=0.02) and left atrial volume (38.0±9.4 versus 28.1±6.5 mL/m2, p<0.001) but similar prevalence of hypertension, diabetes mellitus, coronary artery disease and obstructive sleep apnea. Baseline peak oxygen consumption (VO2peak) was similar between ParAF and PerAF groups (20.0±6.0 versus 19.6±5.4mL/kg/min). Over the 12-month follow-up, AF recurrence in the ParAF patients was lower in the exercise group compared to control group (Hazard Ratio 0.42, 95% CI: 0.23-0.77, p=0.005). However, we did not find evidence of any between-group difference amongst patients with PerAF (HR 0.65, 95% CI: 0.34-1.23). Conclusions In this post-hoc analysis of a randomised controlled trial comparing the efficacy of exercise intervention versus standard medical care amongst patients with symptomatic AF, we observed a reduction in AF recurrence for patients with ParAF, but not amongst those with PerAF. These findings support the need for early lifestyle modification amongst patients with AF, before progression to PerAF occurs. Future studies should explore whether the exercise prescription can be modified to improve outcomes for patients with more advanced AF.