Reversal of atrial substrate to prevent atrial fibrillation

Atrial fibrillation (AF) is an abnormal heart rhythm that comes from the upper chambers of the heart. Atrial fibrillation causes the main pumping chambers of the heart to beat in an irregular and sometimes very rapid fashion. Some people with atrial fibrillation feel completely well. Others feel unwell, with palpitations, a feeling of shortness of breath, reduced exercise ability, lightheadedness or chest pain. Atrial fibrillation is not usually a dangerous rhythm but can cause you to feel unwell and can reduce your quality of life. If atrial fibrillation causes significant symptoms, catheter ablation is often used to try to prevent it from coming back. Catheter ablation involves putting special wires up through the veins of the legs to record the electrical signals of the heart and to cauterize the areas of the heart that cause this abnormal rhythm. The cure rate is between 50 and 70%. There may be ways to improve this cure rate significantly, reducing the need for second and third procedures for this problem with treatment of risk factors and exercise. With each procedure, the risks for major and minor complications is up to 6%, with a risk of death of 1 in 1000. Objective: We propose to determine if a combined home-based exercise and risk factor treatment reduces the recurrence of atrial fibrillation after a catheter ablation procedure for atrial fibrillation. Methods: This objective will be accomplished by performing a clinical trial whereby patients with persistent AF who will be undergoing catheter ablation to treat their AF will be randomly assigned to one of two treatment groups: 1) aggressive risk factor treatment versus 2) standard therapy. There will be 670 patients required for the entire study. This is the first trial to study the effects of exercise in combination with risk factor treatment on atrial fibrillation in a randomized fashion.