Cardiac rehabilitation in atrial fibrillation patients treated with ablation

Rigshospitalet, The Heart Centre

Oslo 2013

Signe Stelling Risom RN, MSc, PhD student

Agenda

Atrial fibrillation (AF) patients• Atrial fibrillation - psychological and

physical state• Intervention studies improving

outcomesAfter ablation• How are patients doing after ablation?• Rehabilitation for AF patients treated

with ablation

Oslo 2013

Rigshospitalet, The Heart Centre

Atrial Fibrillation

AF affects 1.5 - 2 % of the population in the western countries. The incidence is increasing

AF TypesParoxysmal AF: 20 %Persistent AF: 24 %Permanent AF: 56 %

ESC Guidelines 2012,Zoni-Berisso et al. American Journal of Cardiology 2013

Atrial Fibrillation

The symptoms:

• fatigue• dyspnoea • decreased exercise

tolerance• palpitations• dizziness • syncope

AF increases the risk for:

• early death• apoplexia • other thrombo-embolic events • heart failure

ESC Guidelines 2010

AF and quality of life

General health Physical

function Mental health Social

function

0

20

40

60

80

100

SF-36 Quality of life across AF and other groups

AF patients

CHF patients

Post-MI patients

Healthy controls

After: P. Dorian et al. J Am Coll Cardiol 2000;36(4):1303-9.

Anxiety and depression

• The prevalence of depression and anxiety among patients with AF

• 1/3 of the patients with AF experience increased symptoms of anxiety and depression. That is persistent after 6 months.

Thrall et al. CHEST 2007: 132

Change in living• The patients choose to take it easy,

get a new more relaxing job, to hold a less stressful everyday life.

• Early retirement and a shorter working week is prioritized.

• Patients use a lot of energy and resources on avoidance behaviour.

Deaton et al. Heart Lung 2003: 32(5).Berg and Pedersen Tidsskrift for sygeplejeforskning, 2006:3.

AF and physical exercise

Atwood et al. American Heart Journal, 2007: 153, 4.

Nurse-led care clinics

Hendriks et al. European Heart Jounal 2012; 33, 2692-2699

Psychological interventions for patients with AF

Lakkireddy et al. JACC 2013 Vol. 61, No. 11

Physical exercise for patients with AF

N = 30, permanent AF

Intervention: 8 weeks exercise training 3/ week 1.25 hours in 2 months. 3*15 min aerobics at 70-90 % of HRmax

Results: Increased Cumulated work, Increased QoL, less AF symptoms.

Hegbom et al. Journal of Cardiopulmonary Rehabilitation 2006;26:24/29

Physical exercise for patients with AF

N = 49, permanent AF

Intervention: 12 weeks training, 3/week, 1.3 hours. 70 % of max exercise capacity.

Results: Increased work capacity (Watt, 6 MWT), decreased resting pulse, increased QoL

Osbak et al. J Rehabil Med, 2012: 44

Catheter Ablation treatment

A meta-analysis (2009): Overall succesrate: 77 %

Calkins H et al. 2009 Circ Arrhythm Electrophysiol

Sang et al. Clin.Cardiol. 2013: 36,1.

QoL after ablation

Wokhlu et al. JACC 2010: vol. 55 no. 21

Rigshospitalet, The Heart Centre

QoL based on rhythm control post ablation rhythm status

QoL after ablation

Physical exercise after ablation

No studies found

CopenHeartRFA

RCT, N = 210Randomised to: 12 weeks of physical exercise and

4 consultations with a specially trained nurse plus usual care OR usual care only.

Primary outcome: VO2 Peak, ergospirometry testing

Secondary outcome: self-assessed mental health, SF36

Inclusion status to day: 145 patients

SS Risom et al. 2013 BMJ Open. Feb 20;3(2).

Experiences from the CopenHeart study – after ablation

Atrial fibrillation

No control over own body

What can I do to prevent attacks

Warfarin treatment

Insecure about the future

Time -hospitalisation, communication

Affects their manhood – to be sick

Physical activity

Oslo 2013

Rigshospitalet, The Heart Centre

signe.stelling.risom@rh.regionh.dk

CopenHeart.org