Elliott, A.D.Verdicchio, C.V.Mahajan, R.Middeldorp, M.E.Gallagher, C.Mishima, R.S.Hendriks, J.M.L.Pathak, R.K.Thomas, G.Lau, D.H.Sanders, P.2023-09-202023-09-202023JACC: Clinical Electrophysiology, 2023; 9(4):455-4652405-500X2405-5018https://hdl.handle.net/2440/139513Background There are limited data on the effect of exercise interventions on atrial fibrillation (AF) recurrence and symptoms. Objectives The aim of this study was to determine the efficacy of an exercise and physical activity intervention on AF burden and symptoms among patients with symptomatic AF. Methods This prospective, randomized controlled trial included 120 patients with paroxysmal or persistent, symptomatic AF, randomized 1:1 to receive an exercise intervention, combining home and supervised aerobic exercise over 6 months, or to receive usual care. The coprimary outcomes were: 1) AF recurrence, off antiarrhythmic medications and without catheter ablation; and 2) symptom severity assessed by using a validated questionnaire. Results By 12 months, freedom from AF was achieved in 24 (40%) of 60 patients in the exercise group and 12 (20%) of 60 patients in the control group (HR: 0.50: 95% CI: 0.33 to 0.78). At 6 months, AF symptom severity was lower in the exercise group compared with the control group (mean difference –2.3; 95% CI: –4.3 to –0.2; P = 0.033). This difference persisted at 12 months (–2.3; 95% CI: –4.5 to –0.1; P = 0.041). Total symptom burden was lower at 6 months in the exercise group but not at 12 months. Peak oxygen consumption was increased in the exercise group at both 6 and 12 months. There were no between-group differences in cardiac structure or function, body mass index, or blood pressure. Conclusions Participation in an exercise-based intervention over 6 months reduced arrhythmia recurrence and improved symptom severity among patients with AF. (A Lifestyle-based, PhysiCal AcTIVity IntErvention for Patients With Symptomatic Atrial Fibrillation [the ACTIVE-AF Study]; ACTRN12615000734561).en© 2023 Published by Elsevier on behalf of The American College of Cardiology Foundation. All Rights Reserved.arrhythmia; cardiorespiratory fitness; exercise; risk factorsHumansAtrial FibrillationAnti-Arrhythmia AgentsExerciseProspective StudiesJournal article10.1016/j.jacep.2022.12.0022023-09-20632689Elliott, A.D. [0000-0002-5951-4239]Verdicchio, C.V. [0000-0002-9232-0997]Mahajan, R. [0000-0003-3375-5568]Middeldorp, M.E. [0000-0002-4106-9771]Gallagher, C. [0000-0002-5114-400X]Mishima, R.S. [0000-0001-5163-7130]Hendriks, J.M.L. [0000-0003-4326-9256]Pathak, R.K. [0000-0002-7391-6867]Thomas, G. [0000-0002-2307-1560]Lau, D.H. [0000-0001-7753-1318] [0000-0002-1564-439X]Sanders, P. [0000-0003-3803-8429]