50Restoration of sinus rhythm improves exercise capacity in patients with persistent atrial fibrillation: a meta-analysis

Abstract

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the world and is directly associated with an increased risk of stroke, heart failure and mortality. Patients with AF commonly experience a broad range of symptoms including; palpitations, shortness of breath, dizziness, fatigue and a decreased quality of life. Reduced exercise tolerance is another commonly reported symptom of AF. Objective: This meta-analysis assesses the changes in exercise capacity in patients with persistent AF on restoration of sinus rhythm (SR). Methods: MEDLINE/ EMBASE/ COCHRANE were searched for studies reporting changes to exercise capacity following restoration of SR via cardioversion or catheter ablation in patients with persistent AF. From the search 618 articles were identified. After exclusions, 13 studies reporting changes in exercise capacity with or without the restoration of SR were selected. Data was analyzed by a random-effects metaanalysis. Results: Thirteen studies (1,643 individuals with persistent AF, 60 ± 3 years) analyzed change in exercise capacity parameters using oxygen uptake, METs, duration and 6MWT. Exercise capacity significantly improved following successful restoration of SR compared to those who remained in AF (Standardized Mean Difference: 1.91, 95% CI 1.19-2.63, p < 0.001, I2 = 97%). Both treatment modes significantly favor improvements in exercise capacity in SR with moderate effect size with ablation (n = 3) (SMD: 0.98, 95% CI 0.03-1.92) over 24 ± 2 weeks and large effect size with cardioversion (n = 10) (SMD 2.19, 95% CI 1.30-3.09) over 20 ± 24 weeks. There were significant increases in mean differences across all exercise parameters in SR; oxygen uptake (5ml/kg/min, 95% CI 4.09-5.79), METs (3.2, 95% CI 2.5-3.87), duration (73secs, 95% CI 38.85-106.59) and 6MWT (55.15m, 95% CI 45.37-64.93). Conclusion: Successful restoration of SR results in an objective improvement in exercise capacity and may allow AF patients to engage in more active lifestyles and enhance quality of life. (Figure presented).