Atrial fibrillation and cardiac rehabilitation: an overview

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its frequency will only continue to increase in the future. Despite available drug and electrophysical treatments, death and functional restrictions due to AF are still common. More comprehensive standards of care are therefore needed. Purpose: After a foreword regarding the link between physical activity and AF, this article aims to give to the clinician an overview of the benefits he may expect or not when including patients suffering from AF in a cardiac rehabilitation programme. Method: We selected prospective, randomised controlled trials published during the past 10 years and referenced in the PubMed Database evaluating the safety of rehabilitation and/or its impact on AF incidence or tolerance, and tried to summarise them to propose a narrative review. Conclusion: Cardiac rehabilitation, along with moderate and regular physical activity, has been proven to reduce the time in arrhythmia of patients with paroxysmal and persistent AF. In chronic AF, cardiac rehabilitation may decrease the resting ventricular response rate in patients and therefore improve symptoms linked to arrhythmia. These studies have managed to demonstrate cardiac rehabilitation as a safe and manageable option for AF patients, without serious risk of additional side effects. Its efficiency to limit the occurrence of serious undesirable outcomes, such as mortality and hospitalisation, has not been adequately demonstrated, likely due to the small scale of most studies and lack of long-term follow-up. Large-scale and long-term studies are thus desirable.