No benefits from exercise training and worse outcomes in heart failure patients with atrial fibrillation and cardiovascular implantable electronic devices.
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Institute of Cardiology, Warsaw, Poland
Kardiologie/Innere Medizin I Department, Helios Klinikum, Schleswig
2nd Clinic of Coronary Artery Disease, Warsaw, Poland
Maciej Sterliński   

Institute of Cardiology, Warsaw, Poland, Alpejska 42, 04-628 Warszawa, Poland
Publication date: 2018-11-19
Heart Beat 2018;3:61–68
Exercise training (ExT) in patients with heart failure and reduced ejection fraction (HFrEF) improves clinical condition and prognosis. The aim was the impact of exercise training in patients with HFrEF, CRT-D or ICD and AFib

Material and methods:
Patients with CRT-D or ICD with HFrEF (124 pts; 39.5% AFib, 60.5% SR) were randomly assigned to a training program for six months. CPX and standard echo were performed at discharge and follow-up (FU).

There were no differences in training programme for pts. with AFib (44.9%) and with SR (50.7%, ns). CPX FU parameters in the AFib group did not change, but were worse than in the SR. Survival rate was 0.75 and was significantly higher among the 75 patients who hadn’t AFib (0.80) than among the 49 patients with AFib (0.63, log-rank p=0.0098). Of the 77 patients who had CRT-D implanted, survival rate was equal 0.60 in AFib group, and 0.83 in no-AFib group (log-rank p=0.0259). Of the 47 patients who had ICD implanted, survival rates were the same regardless of the presence of AFib (0.66, 0.67, log-rank p=0.58). Mortality independent risk factors were female gender and AFib. LVEF was a factor of better prognosis.

Patients with HFrEF, ICD or CRT-D and AFib were not deriving advantages from a six months training program. Mortality risk factors were female gender and AFib.