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Previous Exercise Levels and Outcome in Patients With New AF
Quick Takes
- Previous sport/exercise lifetime history in patients who develop AF does not appear to affect AF type, cardiovascular outcome, or need for cardioversion or ablation.
- The primary driver of cardiovascular outcome in this study was AF-related events.
- Current exercise practices, not evaluated in this study, may affect AF outcomes.
Study Questions:
In patients who develop atrial fibrillation (AF), does the amount of previous lifetime hours of sport/exercise impact the form of AF, cardiovascular outcomes, and/or the need for cardioversion and ablation?
Methods:
This is a post hoc analysis of the multicenter RACE 4 randomized trial, which evaluated care in newly referred AF patients. For this study, a subgroup of patients (n = 879) who completed total lifetime sports/exercise questionnaires were selected, and categorized into one of three groups for comparison based on lifetime exercise levels: high-dynamic (>150 min/wk high-intensity exercise, n = 203), high (>150 min/wk low-intensity + 75-150/week high-intensity exercise, n = 192), and low (<150 min/wk low-intensity + <75 min/wk high-intensity exercise). The primary endpoint was a composite of cardiovascular death; hospital admission for arrhythmia, heart failure, thromboembolic events, major bleeding, acute coronary syndrome, or life-threatening effects of drug; and, in patients with paroxysmal AF, the need for atrial ablation or cardioversion (chemical and electrical).
Results:
The low lifetime-hours group was significantly older, with higher CHA2DS2-VASc scores and serum cholesterol levels than the other two groups. Also, they used more rate-controlling medications than the high-dynamic lifetime-hours group. The high-dynamic lifetime-hours group had significantly more males (81%) than high (75%) and low (65%) lifetime-hours groups and significantly higher maximum heart rate. Also, the high-dynamic group had significantly higher maximum power during exercise testing and larger right atrial volumes on echocardiography compared with the low lifetime-hours group.
The AF characteristics were comparable between the three groups. At 36-month follow-up, there were no significant differences between groups in the occurrence of the primary endpoint: high-dynamic (30%), high (27%), and low (28%), which was AF-related hospitalizations in all three groups. During follow-up of 562 patients with paroxysmal AF at baseline, there was no significant difference between groups in the requirement for chemical cardioversion, electrical cardioversion, or atrial ablation: high-dynamic (33%), high (32%), and low (35%).
Conclusions:
This post hoc analysis of RACE 4 trial data demonstrates that previous high-dynamic lifetime sport/exercise patients do not appear to have a more benign (or more malignant) type of AF once it occurs later in life. The primary outcome was AF-related hospitalization for all three groups, and there was no difference between groups in the need for chemical cardioversion, electrical cardioversion, or atrial ablation.
Perspective:
Cardiorespiratory fitness is an independent predictor of cardiovascular outcome and all-cause and cardiovascular mortality and, as such, foundational in the prevention and treatment of cardiovascular disease, including AF. However, the development of cardiovascular outcomes in patients with AF does not appear to be associated with previous exercises levels in this cohort, and may be more dependent on underlying risk factors. Therefore, history should focus on current versus previous exercise practices, and treatment on management of risk factors.
Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Prevention, Sports and Exercise Cardiology, Atrial Fibrillation/Supraventricular Arrhythmias, Exercise, Cardiovascular Care Team
Keywords: Ablation, Atrial Fibrillation, Exercise, Sports
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