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Cardiorespiratory Fitness May Alter AF Ablation Outcomes

In a single-center retrospective cohort study, patients with the highest level of baseline cardiorespiratory fitness (CRF) had significantly lower rates of arrhythmia recurrence and death than patients with lower levels of CRF.


Investigators analyzed results in 591 consecutive patients (mean age, 66.5 years; 75% male) with symptomatic paroxysmal or persistent AF who underwent de novo AF ablation at their institution. Only patients who had undergone an exercise stress test in the 12 months before AF ablation (average, 4.5 months) were included.Age- and sex-specific predicted metabolic equivalents (METs) were calculated using the St. James model for women and the Veterans Affairs referral model for men. The number of METs achieved was then divided by the predicted METs, and the patients were categorized into low (<85% predicted; n = 152), adequate (85% - 100% predicted; n = 115), and high (>100% predicted; n = 324) CRF groups.Functional capacity was characterized as poor in 56 patients (9.5%), fair in 94 (16.0%), average in 225 (38.1%), good in 169 (28.6%), and high in 47 (8.0%).

During a mean follow-up of 32 months, arrhythmia recurrence was observed in 79% of patients in the low CRF group, 54% of patients in the adequate CRF group, and 27.5% of patients in the high CRF group (P < .0001).Rehospitalization for arrhythmia was required in 18.5%, 38.0%, and 60.5% of cases, respectively, and repeat direct-current cardioversion or ablation was performed in 26.0%, 49.0%, and 65.0%, respectively (P < .0001 for both).Death occurred in 11% of the low-CRF group, compared with 4% in the adequate-CRF group and 2.5% in the high-CRF group.

Heart Rhythm. Published online August  2, 2020. AbstractEditorial