Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation The CARDIO-FIT Study

Rajeev K. Pathak; Adrian Elliott; Melissa E. Middeldorp; Megan Meredith; Abhinav B. Mehta; Rajiv Mahajan; Jeroen M.L. Hendriks; Darragh Twomey; Jonathan M. Kalman; Walter P. Abhayaratna; Dennis H. Lau; Prashanthan Sanders

doi:10.1016/j.jacc.2015.06.488

Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation The CARDIO-FIT Study

Rajeev K. Pathak, Adrian Elliott, Melissa E. Middeldorp, Megan Meredith, Abhinav B. Mehta, Rajiv Mahajan, Jeroen M.L. Hendriks, Darragh Twomey, Jonathan M. Kalman, Walter P. Abhayaratna, Dennis H. Lau, Prashanthan Sanders^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

415 Citations (Scopus)

Abstract

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/m² 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).

Original language	English
Article number	21464
Pages (from-to)	985-996
Number of pages	12
Journal	Journal of the American College of Cardiology
Volume	66
Issue number	9
DOIs	https://doi.org/10.1016/j.jacc.2015.06.488
Publication status	Published - 1 Sept 2015

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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. (2015). Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation The CARDIO-FIT Study. Journal of the American College of Cardiology, 66(9), 985-996. Article 21464. https://doi.org/10.1016/j.jacc.2015.06.488

@article{fe3dba3fae414c02b37c99472ed580e4,

title = "Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation The CARDIO-FIT Study",

abstract = "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/m2 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).",

keywords = "atrial fibrillation, fitness, obesity, physical activity, risk factors, weight loss",

author = "Pathak, {Rajeev K.} and Adrian Elliott and Middeldorp, {Melissa E.} and Megan Meredith and Mehta, {Abhinav B.} and Rajiv Mahajan and Hendriks, {Jeroen M.L.} and Darragh Twomey and Kalman, {Jonathan M.} and Abhayaratna, {Walter P.} and Lau, {Dennis H.} and Prashanthan Sanders",

note = "Publisher Copyright: {\textcopyright} 2015 American College of Cardiology Foundation.",

year = "2015",

month = sep,

day = "1",

doi = "10.1016/j.jacc.2015.06.488",

language = "English",

volume = "66",

pages = "985--996",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc.",

number = "9",

}

Pathak, RK, Elliott, A, Middeldorp, ME, Meredith, M, Mehta, AB, Mahajan, R, Hendriks, JML, Twomey, D, Kalman, JM, Abhayaratna, WP, Lau, DH & Sanders, P 2015, 'Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation The CARDIO-FIT Study', Journal of the American College of Cardiology, vol. 66, no. 9, 21464, pp. 985-996. https://doi.org/10.1016/j.jacc.2015.06.488

TY - JOUR

T1 - Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation The CARDIO-FIT Study

AU - Pathak, Rajeev K.

AU - Elliott, Adrian

AU - Middeldorp, Melissa E.

AU - Meredith, Megan

AU - Mehta, Abhinav B.

AU - Mahajan, Rajiv

AU - Hendriks, Jeroen M.L.

AU - Twomey, Darragh

AU - Kalman, Jonathan M.

AU - Abhayaratna, Walter P.

AU - Lau, Dennis H.

AU - Sanders, Prashanthan

PY - 2015/9/1

Y1 - 2015/9/1

N2 - 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/m2 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).

AB - 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/m2 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).

KW - atrial fibrillation

KW - fitness

KW - obesity

KW - physical activity

KW - risk factors

KW - weight loss

UR - http://www.scopus.com/inward/record.url?scp=84940056811&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2015.06.488

DO - 10.1016/j.jacc.2015.06.488

M3 - Article

SN - 0735-1097

VL - 66

SP - 985

EP - 996

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 9

M1 - 21464

ER -

Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation The CARDIO-FIT Study

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