High baseline cardiorespiratory fitness and a fitness gain of ≥2 METs were associated with significantly greater arrhythmia-free survival in obese patients with atrial fibrillation (p<0.001).
Cohort (n=308)
Does high cardiorespiratory fitness or fitness improvement reduce arrhythmia recurrence in obese individuals with atrial fibrillation?
valor p: p=<0.001
BACKGROUND: Obesity begets atrial fibrillation (AF). Although cardiorespiratory fitness is protective against incident AF in obese individuals, its effect on AF recurrence or the benefit of cardiorespiratory fitness gain is unknown. OBJECTIVES: This study sought to evaluate the role of cardiorespiratory fitness and the incremental benefit of cardiorespiratory fitness improvement on rhythm control in obese individuals with AF. METHODS: Of 1,415 consecutive patients with AF, 825 had a body mass index ≥27 kg/m(2) and were offered risk factor management and participation in a tailored exercise program. After exclusions, 308 patients were included in the analysis. Patients underwent exercise stress testing to determine peak metabolic equivalents (METs). To determine a dose response, cardiorespiratory fitness was categorized as: low (100%). Impact of cardiorespiratory fitness gain was ascertained by the objective gain in fitness at final follow-up (≥2 METs vs. <2 METs). AF rhythm control was determined using 7-day Holter monitoring and AF severity scale questionnaire. RESULTS: There were no differences in baseline characteristics or follow-up duration between the groups defined by cardiorespiratory fitness. Arrhythmia-free survival with and without rhythm control strategies was greatest in patients with high cardiorespiratory fitness compared to adequate or low cardiorespiratory fitness (p < 0.001 for both). AF burden and symptom severity decreased significantly in the group with cardiorespiratory fitness gain ≥2 METs as compared to <2 METs group (p < 0.001 for all). Arrhythmia-free survival with and without rhythm control strategies was greatest in those with METs gain ≥2 compared to those with METs gain <2 in cardiorespiratory fitness (p < 0.001 for both). CONCLUSIONS: Cardiorespiratory fitness predicts arrhythmia recurrence in obese individuals with symptomatic AF. Improvement in cardiorespiratory fitness augments the beneficial effects of weight loss. (Evaluating the Impact of a Weight Loss on the Burden of Atrial Fibrillation AF in Obese Patients; ACTRN12614001123639).
“What's most exciting about this new study is that it is the first to demonstrate that increasing exercise capacity reduces atrial fibrillation risk. These new results, and the cumulative data linking moderate physical activity to reduced atrial fibrillation risk, suggest that until definitive trial data are available, clinicians should recommend moderate exercise training to our patients with atrial fibrillation, not only to reduce atrial fibrillation, but also for its overall cardiovascular benefits.”
Pathak et al. (Tue,) conducted a cohort in Atrial Fibrillation in Obese Individuals (n=308). High cardiorespiratory fitness and fitness gain ≥2 METs vs. Low/adequate fitness and fitness gain <2 METs was evaluated on Arrhythmia-free survival (p=<0.001). High baseline cardiorespiratory fitness and a fitness gain of ≥2 METs were associated with significantly greater arrhythmia-free survival in obese patients with atrial fibrillation (p<0.001).