Cardiac rehabilitation in patients with atrial fibrillation

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality worldwide, accounting for significant public health and economic burdens. Cardiac rehabilitation (CR) is a comprehensive, multidisciplinary program designed to aid patients in recovering from cardiac events and to prevent further complications. The aim of CR is to improve their quality of life and prognosis. It involves continued prognostic stratification, clinical stabilization, optimization of pharmacological and non-pharmacological therapy, management of comorbidities, treatment of disabilities, reinforcement of secondary prevention interventions, and maintenance of adherence to therapy. The most recent European Society of Cardiology guidelines for the diagnosis and management of atrial fibrillation (AF) emphasize the importance of cardiorespiratory fitness, recommending that patients engage in moderate-intensity exercise and remain physically active to prevent AF incidence or recurrence. Through this symbiotic relationship, CR addresses all aspect of cardiac fitness in AF management. The program's structured exercise regimens are specifically tailored to address the challenges associated with AF, promoting overall cardiovascular health and reducing the risk for cardiac death. CR is also crucial for emotional well-being, offering support and coping mechanisms for the psychological impact of AF, beyond the physical training program. CR programs involve a multidisciplinary approach that is carried out collaboratively by a team of healthcare professionals, including nurses, physiotherapists, psychologists, and dietitians. Moreover, CR in AF patients aims to carry out comprehensive patient support through clinical stabilization and therapy optimization interventions, prescription and implementation of physical activity, educational support on lifestyle risk factors and social-emotional distress, and periodic assessment of outcomes. This narrative review aims to elucidate the role of CR in AF patients, shedding light on the potential benefits and challenges associated with integrating rehabilitation programs into the care of individuals with AF.