Cardiac rehabilitation and risk factor optimization to prevent atrial fibrillation recurrence after ablation or cardioversion

Abstract Background Cardiovascular risk factors (CVRFs) such as obesity, hypertension, diabetes and sedentary lifestyle substantially contribute to the onset and recurrence of atrial fibrillation (AF). Their combined burden reduces the likelihood of maintaining sinus rhythm after rhythm-control interventions. Although cardiac rehabilitation programmes (CRPs) are recognised for improving overall cardiovascular health, evidence remains limited regarding whether systematic correction of CVRFs through a structured CRP can effectively reduce the risk of AF recurrence. Purpose To evaluate whether participation in a structured CRP focused on intensive risk-factor optimisation is associated with lower AF recurrence after electrical cardioversion or catheter ablation. Methods A retrospective observational study was conducted including patients with paroxysmal or persistent AF in sinus rhythm following electrical cardioversion or ablation. The documented AF recurrence rate during follow-up was compared between patients who completed a multidisciplinary CRP and those who did not, due to refusal or early discontinuation. This CRP incorporated supervised exercise, lifestyle counselling, nutritional guidance and intensive risk-factor management. AF recurrence was defined as any documented episode during long-term follow-up. Results Sixty-four consecutive patients were included between May 2018 and May 2024: 48 completed the CRP and 16 did not participate or discontinued the programme. Median follow-up was 38.5 months (interquartile range 29–55). AF recurrence was significantly lower among CRP participants (22.9%) compared with non-participants (50.0%) (p = 0.049; odds ratio 0.30; 95% confidence interval 0.09–0.98). Kaplan–Meier analysis demonstrated a significantly higher AF-recurrence-free survival in the CRP group (p = 0.044) (Figure 1). Improvements in body composition parameters as body weight, body mass index and visceral fat were observed in the CRP group, consistent with the goals of intensive CVRF management (Table 1). Conclusions In patients with AF and multiple CVRFs, completion of a comprehensive CRP focused on intensive risk-factor optimisation was associated with a substantially lower rate of AF recurrence during long-term follow-up after rhythm-control interventions. These findings support the integration of structured, multidisciplinary rehabilitation strategies into standardised AF management pathways to enhance the maintenance of sinus rhythm.For image description, please refer to the figure legend and surrounding text. Baseline characteristics and outcomes.For image description, please refer to the figure legend and surrounding text.