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Cardiac rehabilitation in atrial fibrillation patients treated with ablation

Cardiac rehabilitation in atrial fibrillation patients treated with ablation. Signe Stelling Risom RN, MSc, PhD student. Agenda. Atrial fibrillation (AF) patients Atrial fibrillation - psychological and physical state Intervention studies improving outcomes After ablation

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Cardiac rehabilitation in atrial fibrillation patients treated with ablation

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  1. Rigshospitalet, The Heart Centre Cardiac rehabilitation in atrial fibrillation patients treated with ablation Signe Stelling Risom RN, MSc, PhD student

  2. Rigshospitalet, The Heart Centre Agenda • Atrial fibrillation (AF) patients • Atrial fibrillation - psychological and physical state • Intervention studies improving outcomes • After ablation • How are patients doing after ablation? • Rehabilitation for AF patients treated with ablation

  3. Atrial Fibrillation AF affects 1.5 - 2 % of the population in the western countries. The incidence is increasing AF Types Paroxysmal AF: 20 % Persistent AF: 24 % Permanent AF: 56 % ESC Guidelines 2012, Zoni-Berisso et al. American Journal of Cardiology2013

  4. 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

  5. AF and quality of life After: P. Dorian et al. J Am CollCardiol2000;36(4):1303-9.

  6. 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

  7. 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 Lung2003: 32(5). Berg and Pedersen Tidsskrift for sygeplejeforskning, 2006:3.

  8. AF and physicalexercise Atwood et al. American Heart Journal, 2007: 153, 4.

  9. Nurse-led care clinics Hendriks et al. European Heart Jounal2012; 33, 2692-2699

  10. Psychological interventions for patients with AF Lakkireddy et al. JACC 2013Vol. 61, No. 11

  11. Physicalexercise for patients with AF N = 30, permanent AF Intervention: 8 weeksexercisetraining3/ week 1.25 hours in 2 months. 3*15 min aerobics at 70-90 % of HRmax Results: IncreasedCumulatedwork, IncreasedQoL, less AF symptoms. Hegbom et al. Journal of Cardiopulmonary Rehabilitation 2006;26:24/29

  12. Physicalexercise 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

  13. CatheterAblationtreatment A meta-analysis (2009): Overall succesrate: 77 % Calkins H et al. 2009 Circ ArrhythmElectrophysiol

  14. QoLafter ablation Sang et al. Clin.Cardiol. 2013: 36,1.

  15. Rigshospitalet, The Heart Centre QoLafterablation QoLbasedonrhythmcontrol post ablation rhythm status

  16. Physicalexerciseafterablation No studies found

  17. CopenHeartRFA • RCT, N = 210 • Randomised 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).

  18. Experiences from the CopenHeartstudy – afterablation Insecureabout the future Physicalactivity Warfarintreatment Atrial fibrillation Nocontrol over ownbody Whatcan I do to preventattacks Time -hospitalisation, communication Affectstheirmanhood – to besick

  19. Rigshospitalet, The Heart Centre CopenHeart.org signe.stelling.risom@rh.regionh.dk

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