Combined Effects of Early Rhythm Control and Exercise on Atrial Fibrillation Outcomes: Nationwide Cohort Analysis

The benefit of combining early rhythm control (ERC) and exercise habit change in atrial fibrillation (AF) is unknown.

To evaluate the primary outcomes - major adverse cardiovascular event (MACE) and all-cause death - according to the combination of ERC status and exercise habit change.

From the National Health Information Database, we included 161,379 patients diagnosed with AF. Rhythm control initiated within two-year from AF diagnosis was defined as ERC. Based on the status of regular exercise at serial health examinations before and after AF diagnosis, exercise habit change was categorized into persistent non-exercisers, exercise dropouts, new exercisers, and exercise maintainers.

During a mean follow-up of 4.6 years, ERC was associated with a lower risk of MACE and all-cause death; adjusted hazard ratio (aHR) and 95% confidence interval (CI) was 0.832 (0.797-0.868) for MACE and 0.953 (0.915-0.992) for all-cause death (both p<0.001). Exercise maintenance was also associated with a lower risk of MACE and all-cause death: adjusted HR (95% CI)=0.822 (0.763-0.886) for MACE and 0.708 (0.658-0.762) for all-cause death (both p<0.001). There was a progressive decrease in the risk of MACE and all-cause death as AF patient engaged in ERC or regular exercise; the combination of ERC and exercise maintenance provided the greatest benefit, associated with the lowest risk of MACE [aHR (95% CI)=0.641 (0.576-0.713)] and all-cause death [aHR (95%CI)=0.564 (0.499-0.636)], both p<0.001.

The combination of ERC and exercise maintenance yielded a synergistic effect, maximizing the reduction in MACE and all-cause death risks, highlighting integrated management in AF.