Abstract / Summary
Cardiac rehabilitation (CR) may benefit patients with atrial fibrillation (AF) in areas such as exercise capacity. However, evidence regarding its impact on AF recurrence, a key clinical outcome, remains inconsistent. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the effects of CR on AF recurrence, all-cause mortality, hospitalization, and exercise capacity in patients with AF. We systematically searched the Cochrane Library, PubMed, and Embase from January 1, 1980, to April 20, 2026. Two reviewers independently screened studies, extracted data, and assessed risk of bias. A total of 1,550 patients from 11 RCTs were included in the meta-analysis based on the predefined inclusion and exclusion criteria. Pooled analysis demonstrated a significant reduction in AF recurrence among patients receiving CR compared with controls (risk ratio (RR) 0.77, 95% confidence interval (CI) [0.67-0.89], p = 0.0003, I 2 = 20%). However, this effect was not statistically significant in the exploratory subgroup of patients post-ablation (RR 0.86, 95% CI [0.69-1.07], p = 0.17, I 2 = 0%). Exercise capacity, measured via the 6-minute walking test, significantly improved (weighted mean difference (WMD) 32.22, 95% CI [21.22-43.23], p < 0.00001, I 2 = 0%). No significant differences were observed in all-cause mortality (RR 1.04, 95% CI [0.74-1.46], p = 0.81, I 2 = 0%), hospitalization rates (RR 1.00, 95% CI [0.85-1.19], p = 0.97, I 2 = 0%), or the composite outcome of mortality and hospitalization (RR 1.01, 95% CI [0.90-1.14], p = 0.83, I 2 = 0%). CR is associated with a reduction in AF recurrence in the overall AF population, though this benefit was not observed in the exploratory subgroup of patients post-ablation. It significantly improves exercise capacity but does not appear to affect mortality or hospitalization rates. Further high-quality randomized trials are needed to evaluate the benefits and potential risks of CR across different types of AF.
Primary Source
PeerJ
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