Moderate physical exercise: a simplified approach for ventricular rate control in older patients with atrial fibrillation

Plisienė, Jurgita; Blumberg, A; Haager, Gudrun; Knackstedt, Christian; Latsch, Joachim; Norra, Christine; Arndt, Marlies; Tuerk, Stefan; Heussen, Nicole; Kelm, Malte; Predel, Hans‐Georg; Schauerte, Patrick

doi:10.1007/s00392-008-0692-3

Cited by 35 publications

(37 citation statements)

References 20 publications

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“…24 Nonpharmacological approaches like AV node vagal stimulation, moderate physical exercise, and genetic inhibition of inhibitory Gα protein in the AV node have been successfully tried to overcome these limitations. 5,25,26 Our data indicate that RDN may provide an additional promising strategy for rate control in AF. This rate control effect was observed in a hypertensive patient with permanent AF other than marked BP reductions.…”

Section: Discussionmentioning

confidence: 74%

Renal Sympathetic Denervation Provides Ventricular Rate Control But Does Not Prevent Atrial Electrical Remodeling During Atrial Fibrillation

et al. 2013

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A trial fibrillation (AF) is a frequent complication of longstanding hypertension and represents the most common cardiac arrhythmia causing significant morbidity and mortality.1-3 During AF, normal atrioventricular (AV) node conduction leads to a rapid and irregular ventricular rate, resulting in an impairment of left ventricular function and exercise capacity. 4 Rate control can be achieved by drugs modulating the autonomic nervous system, for example, by β-blockers. Genetic inhibition of inhibitory Gα protein in the AV node reduced heart rate (HR) and prevented AF-associated reduction of cardiac function in a porcine model for persistent AF. 5In addition, AF causes atrial electrical remodeling mainly characterized by a pronounced atrial effective refractory period (AERP) shortening perpetuating AF.6 Alterations in the autonomic nervous system may influence AF-induced atrial electrical remodeling and atrial arrhythmogenesis.7-9 Catheterbased renal denervation (RDN) is a new therapeutic approach to reduce sympathetic activity and blood pressure (BP) and to improve obstructive sleep apnea severity and glucose metabolism in resistant hypertension. [10][11][12][13][14][15] However, the effect of RDN on ventricular HR response during AF (rate control) and AF-induced electrical remodeling is unknown.Herein, we report on the effect of catheter-based RDN, shown previously to reduce renal and whole body sympathetic activity, 12-14 on rate control in a patient with permanent AF and resistant hypertension. Subsequently, we investigated the effect of denervation of the afferent and efferent renal sympathetic nerves in a pig model with short-term AF maintained by rapid atrial pacing. Methods Catheter-Based RDN in a Patient With AFThe patient gave written informed consent. Catheter-based RDN was performed as described previously.11-15 Renal angiogram was performed via femoral access to exclude renal artery stenosis. The treatment catheter (Symplicity Catheter System, Ardian/Medtronic USA) Abstract-Renal denervation (RDN) reduces renal efferent and afferent sympathetic activity thereby lowering blood pressure in resistant hypertension. The effect of modulation of the autonomic nervous system by RDN on atrial electrophysiology and ventricular rate control during atrial fibrillation (AF) is unknown. Here we report a reduction of ventricular heart rate in a patient with permanent AF undergoing RDN. Subsequently, we investigated the effect of RDN on AF-induced shortening of atrial effective refractory period, AF inducibility, and ventricular rate control during AF maintained by rapid atrial pacing in 12 pigs undergoing RDN (n=7) or sham procedure (n=5

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Section: Discussionmentioning

confidence: 74%

Renal Sympathetic Denervation Provides Ventricular Rate Control But Does Not Prevent Atrial Electrical Remodeling During Atrial Fibrillation

et al. 2013

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“…And while patients with AF achieved similar short-term gains in cardiopulmonary reserve and functional status with exercise training, they reported minimal improvement in self-reported health status with exercise. Exercise has been previously shown to modestly improve quality of life and symptoms in patients with permanent AF, but with use of a different health status measure (Short Form-36) (21,27). The use of different instrument scales to assess health status and different types of exercise intervention makes it difficult, however, to compare these results to our study.…”

Section: Discussionmentioning

confidence: 99%

Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation

Luo

Merrill

Parikh

et al. 2017

Journal of the American College of Cardiology

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BACKGROUND The safety and efficacy of aerobic exercise in heart failure (HF) patients with atrial fibrillation (AF) has not been well evaluated. PURPOSE This study examined if outcomes with exercise training in HF vary according to AF status. METHODS HF-ACTION randomized 2331 ambulatory HF patients with ejection fraction ≤35% to exercise training or usual care. We examined clinical characteristics and outcomes (mortality/hospitalization) by baseline AF status (past history of AF or AF on baseline EKG vs. no AF) using adjusted Cox models and explored an interaction with exercise training. We assessed post-randomization AF events diagnosed via hospitalizations for AF and reports of serious arrhythmia caused by AF. RESULTS Of 2292 patients with baseline rhythm data, 382 (17%) had AF, 1602 (70%) had sinus rhythm, and 308 (13%) had “other” rhythm. Patients with AF were older and had lower peak VO2. Over a median follow-up of 2.6 years, AF was associated with a 24% per year higher rate of mortality/hospitalization (hazard ratio [HR] 1.53; 95% CI 1.34–1.74; p <0.001) in unadjusted analysis; this did not remain significant after adjustment (HR 1.15; 95% CI 0.98–1.35; p =0.09). There was no significant difference in AF event rates by randomized treatment assignment in the overall population or by baseline AF status (all p >0.1). There was no interaction between AF and exercise training on measures of functional status or clinical outcomes (all p >0.1). CONCLUSIONS AF in patients with chronic HF was associated with older age, reduced exercise capacity at baseline, and a higher overall rate of clinical events, but not a differential response to exercise training for clinical outcomes or changes in exercise capacity. Clinicaltrials.gov Identifier NCT00047437

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“…For those already diagnosed with atrial fibrillation, regular moderate physical activity is known to increase exercise capacity and control ventricular rate during atrial fibrillation. 598 Patients without structural disease and in the absence of WPW syndrome can safely perform moderate-intensity isometric and isotonic exercises, depending in part on the presence and severity of underlying CVD. Exercise training response in patients with chronic atrial fibrillation is not impaired, and exercise capacity improves.…”

Section: Atrial Fibrillationmentioning

confidence: 99%

Exercise Standards for Testing and Training

Fletcher¹,

Ades²,

Kligfield³

et al. 2013

Circulation

1,626

760

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Moderate physical exercise: a simplified approach for ventricular rate control in older patients with atrial fibrillation

Abstract: Regular moderate physical activity decreases VR at rest and during exercise while increasing exercise capacity. Physical training should be taken into account for ventricular rate control during AF.

Cited by 35 publications

References 20 publications

Renal Sympathetic Denervation Provides Ventricular Rate Control But Does Not Prevent Atrial Electrical Remodeling During Atrial Fibrillation

Renal Sympathetic Denervation Provides Ventricular Rate Control But Does Not Prevent Atrial Electrical Remodeling During Atrial Fibrillation

Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation

Exercise Standards for Testing and Training

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