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Pre-Ablation Fitness Prevents Recurrence of Atrial Fibrillation

If you are physically fit before your catheter ablation for atrial fibrillation, you have a “much higher chance” of benefiting from the procedure and remaining in normal sinus rhythm (NSR). That’s the findings of a study from the Cleveland Clinic.

Less fit patients have more recurrence, are hospitalized more often, have to continue taking antiarrhythmic drugs longer, and have higher death rates.

Cleveland Clinic Physiology Fitness Study of A-Fib Patients (2012-2018)

In this study from the Cleveland Clinic, the participants were 591 patients scheduled to have their first catheter ablation for A-Fib.

Cardiorespiratory Fitness (CRF) relates to the ability of the circulatory and respiratory systems to supply oxygen during sustained physical activity.

In the 12 months prior to their ablation, all were tested for fitness on a treadmill. Patients’ fitness was ranked as low, adequate, or high according to their Cardiorespiratory Fitness (CRF).

Astonishing Results: The Impact of Fitness

At 32+ months after ablation, findings among the three groups include:

Recurrence rate of:

• 79% of the low fitness group
• 54% of the adequate fitness group
• 5% in the high fitness group

Antiarrhythmic Drugs Use Discontinued in:

• 56% of the high fitness group
• 11% of the low fitness group

Mortality rate of:

• 11% of low fitness group
• 5% of high fitness group
• 4% of adequate fitness group

Comorbidities

Other diseases such as hypertension, diabetes, and obstructive sleep apnea were similar across all three groups.

Study Implications

According to lead investigator Wael A. Jaber:

“Being fit is a great antiarrhythmic… . High physical fitness can keep you in rhythm after A-Fib ablation… . Being physically fit acted almost like a medication…”

Previous Studies about Exercise

Previous studies have shown that exercise, weight loss, and similar lifestyle modifications not only improve A-Fib symptoms, but in some cases even result in freedom from A-Fib.

Lack of fitness has been shown to predict A-Fib and arrhythmia recurrence.

Exercise, weight loss, and similar lifestyle modifications can improve A-Fib symptoms, and in some cases lead to freedom from A-Fib.

Dr. Prashanthan Sanders of Adelaide, Australia has described the great results he is getting in his clinic which includes a weight loss program and counseling. He convinces his overweight patients to buy into the program, lose weight, and keep it off.

The program works so well that just by losing weight patients become A-Fib free.

This program is a holistic approach to health and also is developed to work for diabetes, sleep apnea, hypertension, binge drinking and smoking.

Requiring or Recommending Fitness Program for A-Fib?

The Cleveland Clinic study is probably the first study to look at the effect fitness has on patient outcomes after ablation.

Physical fitness improves your A-Fib symptoms and ablation outcomes.

The results are so convincing we need to look at whether a fitness program before an ablation may alter and improve the chances of a successful A-Fib ablation. i. e., “survival of the fittest.”

For example, many A-Fib centers now routinely require patients with sleep apnea to get treatment before they can get an ablation.

Could this be done for patients with poor fitness as well? (Unfortunately, poor fitness is often a result of being in A-Fib with lower ability to exercise adequately.)

Managing Comorbidities: Many A-Fib centers now target the monitoring and improvement in blood pressure, glycemic control and weight loss in patients with A-Fib. Perhaps, better fitness and exercise capacity should probably be added to this target list, especially before an ablation.

More Study Data Needed: An important follow-up clinical study would be to determine whether modifying fitness prior to ablation improves outcomes.

Bottom Line for A-Fib Patients Considering Catheter Ablation

All A-Fib patients should work to be as fit as they can be. It’s especially important before a catheter ablation.

Exercise and manage any comorbidities. Address your sleep apnea. Lose weight and/or maintain a healthy weight. Eat a healthy diet and limit alcohol consumption. These life choices can reduce or help manage high blood pressure and diabetes.

Resources for this article

• Donnellan E, et all. Higher baseline cardiorespiratory fitness is associated with lower arrhythmia recurrence and death after atrial fibrillation ablation. Heart Rhythm. 2020 Oct;17(10):1687-1693. doi: 10.1016/j.hrthm.2020.05.013. Epub 2020 Aug 3. PMID: 32762978

• Fitness linked to lower arrhythmia recurrence after AF ablation. Cardiac Rhythm News. August 7, 2010. https://tinyurl.com/AFIBFitnessAblationRecurrence

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