Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation: Results of the randomized CopenHeartRFAtrial.
BACKGROUND
To assess the effects of comprehensive cardiac rehabilitation compared with usual care on physical activity and mental health for patients treated with catheter ablation for atrial fibrillation.


METHODS
The patients were randomized 1:1 stratified by paroxysmal or persistent atrial fibrillation and sex to cardiac rehabilitation consisting of 12 weeks physical exercise and four psycho-educational consultations plus usual care (cardiac rehabilitation group) versus usual care. The primary outcome was Vo2peak. The secondary outcome was self-rated mental health measured by the Short Form-36 questionnaire. Exploratory outcomes were collected.


RESULTS
210 patients were included (mean age: 59 years, 74% men), 72% had paroxysmal atrial fibrillation prior to ablation. Compared with usual care, the cardiac rehabilitation group had a beneficial effect on Vo2peak at four months (24.3mL kg-1min-1versus 20.7mL kg-1min-1, p of main effect=0.003, p of interaction between time and intervention=0.020). No significant difference between groups on Short Form-36 was found (53.8 versus 51.9 points, P=.20). Two serious adverse events (atrial fibrillation in relation to physical exercise and death unrelated to rehabilitation) occurred in the cardiac rehabilitation group versus one in the usual care group (death unrelated to intervention) (P=.56). In the cardiac rehabilitation group 16 patients versus 7 in the usual care group reported non-serious adverse events (P=.047).


CONCLUSIONS
Comprehensive cardiac rehabilitation had a positive effect on physical capacity compared with usual care, but not on mental health. Cardiac rehabilitation caused more non-serious adverse events.
Rigshospitalet, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark; Department of Nursing, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark. Electronic address: Signe.stelling.risom@regionh.dk.
Signe S
SS
Risom
Rigshospitalet, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark; National Centre of Rehabilitation and Palliation, University of Southern Denmark, Odense University Hospital, Odense C, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Ann-Dorthe
AD
Zwisler
Rigshospitalet, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark; Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.
Trine B
TB
Rasmussen
Rigshospitalet, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
Kirstine Lærum
KL
Sibilitz
Department of Nursing, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark.
Trine L S
TL
Madsen
Rigshospitalet, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark; The Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark.
Jesper Hastrup
JH
Svendsen
Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Denmark.
Christian
C
Gluud
Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Denmark.
Jane
J
Lindschou
Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Denmark.
Per
P
Winkel
Rigshospitalet, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Selina Kikkenborg
SK
Berg
D000359:Aftercare; D000368:Aged; D001281:Atrial Fibrillation / Q000523:psychology / Q000534:rehabilitation / Q000601:surgery*; D000072038:Cardiac Rehabilitation / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D003718:Denmark; D005080:Exercise Test; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010101:Oxygen Consumption; D010353:Patient Education as Topic; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome