Physical Exercise Intervention Improves Cardiac Function and Reduce Recurrences in Non-permanent Atrial Fibrillation:...

Evidences indicate positive effect of physical exercise on exercise capacity and quality of life in patients with AF. However, whether it improves cardiac function and reverse cardiac remodeling in AF patients was unknown. We aim to evaluate the effects of exercise intervention on cardiac function and structure, and the risk of AF recurrence in patients with non-permanent AF.

A systematic review and meta-analysis was conducted following PRISMA guidelines. Searches were performed in PubMed, ProQuest, Google Scholar, ScienceDirect, and Scopus to identify randomized controlled trials (RCTs) comparing exercise interventions combined with standard AF treatment versus standard treatment alone in patients with non-permanent AF. The outcomes included changes in LVEF, left atrial indexed volume (LAVi), the E/e' ratio (early mitral inflow velocity/early diastolic mitral annular velocity), left ventricular end-diastolic diameter (LVDd), and the incidence of AF recurrence.

A total of ten RCTs involving 1013 participants met the inclusion criteria. The intervention group participated in supervised exercise sessions, with or without additional home-based exercise, alongside routine AF treatment. Exercise modalities varied, mostly included continuous or interval aerobic training ± strength training. The analysis revealed a significant increase in LVEF following exercise intervention (MD = 2.16 %, 95 % CI: 0.27 to 4.05, p = 0.03, I² = 74 %). However, no significant differences were observed in LAVi, LVDd, or the E/e' ratio. Interestingly, exercise intervention was associated with a reduced risk of AF recurrence compared to the control group (RR = 0.82, 95 % CI: 0.68 to 0.99, p = 0.04, I² = 33 %). Subgroup analysis revealed that interval training appears to offer greater benefit in reducing AF recurrence, while continous training results in greater improvement of LVEF.

Exercise intervention improves LVEF and reduces AF recurrence, but does not affect cardiac remodeling. This effect is dependent on the type of exercise regimen.