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Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation
Open accessAbstract
Background Obesity begets atrial fibrillation (AF). Although cardiorespiratory fitness is protective against incident AF in obese individuals, its effect on AF recurrence or the benefit of cardiorespiratory fitness gain is unknown.Objectives This study sought to evaluate the role of cardiorespiratory fitness and the incremental benefit of cardiorespiratory fitness improvement on rhythm control in obese individuals with AF.Methods Of 1,415 consecutive patients with AF, 825 had a body mass index ≥27 kg/m(2) and were offered risk factor management and participation in a tailored exercise program. After exclusions, 308 patients were included in the analysis. Patients underwent exercise stress testing to determine peak metabolic equivalents (METs). To determine a dose response, cardiorespiratory fitness was categorized as: low (<85%), adequate (86% to 100%), and high (>100%). Impact of cardiorespiratory fitness gain was ascertained by the objective gain in fitness at final follow-up (≥2 METs vs. <2 METs). AF rhythm control was determined using 7-day Holter monitoring and AF severity scale questionnaire.Results There were no differences in baseline characteristics or follow-up duration between the groups defined by cardiorespiratory fitness. Arrhythmia-free survival with and without rhythm control strategies was greatest in patients with high cardiorespiratory fitness compared to adequate or low cardiorespiratory fitness (p < 0.001 for both). AF burden and symptom severity decreased significantly in the group with cardiorespiratory fitness gain ≥2 METs as compared to <2 METs group (p < 0.001 for all). Arrhythmia-free survival with and without rhythm control strategies was greatest in those with METs gain ≥2 compared to those with METs gain <2 in cardiorespiratory fitness (p < 0.001 for both).Conclusions Cardiorespiratory fitness predicts arrhythmia recurrence in obese individuals with symptomatic AF. Improvement in cardiorespiratory fitness augments the beneficial effects of weight loss. (Evaluating the Impact of a Weight Loss on the Burden of Atrial Fibrillation [AF] in Obese Patients; ACTRN12614001123639).
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“Improved cardiorespiratory fitness can further decrease AF burden in obese patients with AF.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [297]
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Metadata
- Authors
- Pathak, R. K., Elliott, A., Middeldorp, M. E., Meredith, M., Mehta, A. B., Mahajan, R., Hendriks, J. M. L., Twomey, D., Kalman, J. M., Abhayaratna, W. P., Lau, D. H., & Sanders, P.
- Affiliations
- Royal Adelaide Hospital (AU)
- Australian National University (AU)
- The Royal Melbourne Hospital (AU)
- Corresponding author
- Sanders, Prashanthan
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-09
- Volume
- 66
- Issue
- 9
- Pages
- 985-996
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W776843255
- Cited by
- 544
- References
- 31
- Citations by year
- 2026: 33 · 2025: 51 · 2024: 46 · 2023: 36 · 2022: 43 · 2021: 52 · 2020: 66 · 2019: 48 · 2018: 46 · 2017: 54 · 2016: 53 · 2015: 13
- FWCI
- 40.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- University of Adelaide
- Centre for Heart Rhythm Disorders, University of Adelaide
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Keywords
- cardiorespiratory fitness, atrial fibrillation, obesity, arrhythmia recurrence, rhythm control, exercise training, weight loss, peak metabolic equivalents, arrhythmia burden, Holter monitoring
- MeSH terms
- Aged, Atrial Fibrillation, Australia, Cardiovascular Diseases, Electrocardiography, Exercise Test, Female, Humans, Male, Middle Aged, Motor Activity, Obesity, Physical Fitness, Prognosis, Recurrence, Retrospective Studies, Severity of Illness Index, Cohort Studies, Comorbidity, Body Mass Index, Survival Analysis, Catheter Ablation, Age Distribution, Sex Distribution, Risk Assessment
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