Safety and Effectiveness of Exercise-Based Cardiac Rehabilitation for Patients With Atrial Fibrillation Following Radiofrequency Catheter Ablation Therapy: A Systematic Review and Meta-Analysis

Despite the potential of cardiac rehabilitation (CR) to reduce atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA), its prescription is not routine. We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of CR in this setting. Inclusion criteria comprised randomized controlled trials (RCTs) comparing CR with usual care in patients with AF following RFCA. We performed a comprehensive search of six databases up to August 17, 2023, and conducted a thorough risk of bias assessment. We synthesized safety outcomes using AF recurrence rates to calculate relative risks (RR). Furthermore, we conducted a meta-analysis on peak oxygen uptake (VO2 peak) and the six-minute walk test (6MWT) to gauge efficacy, utilizing mean differences (MD) for comparison. The GRADE framework was employed to determine the certainty of evidence, with two independent reviewers completing all processes. Our analysis encompassed eight studies with 772 participants aged 55-70 years engaged in moderate-intensity CR for a median of six months. Results showed no significant difference in AF recurrence after CR (RR = 0.69 (0.41-1.14)), with low evidence certainty due to heterogeneity. Subgroup analyses suggested a poor risk reduction effect in patients with obesity and persistent AF. Significant improvements were observed in VO2 peak and 6MWT outcomes (VO2 peak; MD = 2.53 (0.78-4.28), 6MWT; MD = 38.81 (0.65-76.97)), with moderate-certainty evidence. While CR may decrease AF recurrence after RFCA, its effectiveness varies, potentially diminishing in patients with obesity or persistent AF. Moderate gains in physical performance were achieved with minimal adverse events. Further RCTs are warranted to confirm these findings.