Efficacy of Personalized Exercise Program and Trimetazidine in Rehabilitation of Patients After RFA of AF

Clinical Efficacy of Personalized Exercise Program and an Inhibitor of Fatty Acid β-oxidation in Rehabilitation of Patients With Atrial Fibrillation After Primary Radiofrequency Ablation of Pulmonary Venous Orifices

Atrial fibrillation (AF) is one of the most common forms of heart rhythm disorder in patients with cardiovascular diseases. The choice of treatment for AF is a complex problem, depending on the form (paroxysmal, persistent, permanent) of AF, clinical manifestations of cardiac arrhythmias, associated diseases, the effectiveness of antiarrhythmic drugs. The accumulated data to date indicate an efficacy of the method of radiofrequency ablation (RFA) in the treatment of the paroxysmal form of AF. The RFA procedure does not eliminate the pathological processes that take place during developed AF. This dictates the need to develop and test new technologies and physical rehabilitation programmes for patients. The positive clinical effects of physical rehabilitation programmes based on moderate-intensity exercises are well known. The search for drugs capable of improving the results of RFA for AF in patients becomes urgent. This creates the prerequisites for the study of the clinical efficacy of trimetazidine MV in the rehabilitation of patients with cardiac diseases who underwent treatment of AF with RFA, which will optimize the management of such patients in the inpatient and outpatient setting.

The study is interventional (Clinical Trial), randomized in parallel groups. Enrollment: 72 participants.

The 72 male patients were randomized in 3 groups. In 1st group (control) patients were taken antiarrhythmical drugs and anticoagulants. They did only usual activity without walking. Patients in 2nd group were taken antiarrhythmical drugs and anticoagulants, participated in rehabilitation programme. Twice a week they came in clinical center to engage in physical training with an instructor. The programe was lasted for 6 months. Also patients did they usual physical activity, practiced walking. Patients in 3rd group were taken antiarrhythmical drugs and anticoagulants, selective inhibitor of fat acids oxidation for 6 months. They did only usual activity without walking.

The examination was carried for all 72 patients. Before RFA patients took blood tests, performed echocardiography, completed psychological questionnaires. After 3 days they took blood tests, performed 6-minute walk testing, ECG monitoring, completed psychological questionnaires. One month after RFA patient performed veloergometry testing. Three months after RFA the performed 6-minute walk testing, ECG monitoring, took blood tests, completed psychological questionnaires. Six months after RFA patients took blood tests, performed echocardiography, 6-minute walk testing, ECG monitoring, veloergometry testing, completed psychological questionnaires. Onward was a follow up period for 6 months. At the time point of 12 months patients took blood tests, performed echocardiography, ECG monitoring, veloergometry testing, completed psychological questionnaires.

Inclusion Criteria:

• treated for atrial fibrillation with radiofrequency ablation
• cardiac disease
• providing written informed consent

Exclusion Criteria:

• Congenital and acquired heart defects.
• Acute coronary syndrome (unstable angina, myocardial infarction), myocardial revascularization during the previous 6 months
• Transient ischemic attack, stroke in history.
• Arterial hypertension (BP ≥160/100 мм. рт. ст.)
• The risk of thromboembolic complications on a scale CHA2DS2-VASc> 2
• Risk of hemorrhagic complications of anticoagulant therapy (HAS-BLED> 3 points on the scale).
• Complications after RFA.
• Chronic heart failure above III FC (NYHA), ejection fraction (EF) <40%.
• Acute thrombophlebitis, complicated forms of varicose veins (thrombophlebitis, phlebothrombosis).
• Pronounced atherosclerosis of peripheral arteries (intermittent claudication), requiring surgical intervention.
• Violation of conductivity: AV-blockade 2-3 degrees, complete blockade of the bundle of the His bundle
• The presence of an implanted pacemaker pacemaker / pacemaker with a resynchronization function/cardioverter-defibrillator)
• Conduct RFA on AF earlier.
• The presence of a history of syncopal states.
• Diabetes mellitus type 1 and 2 in the stage of decompensation.
• Acute conditions: infection, exacerbation of chronic diseases in a period of less than 1 month prior to the study; severe injury, surgical interventions other than RFA for a period of less than 2 months from the start of the study
• Renal failure (creatinine levels above 300 µmol / L or 3.5 mg / dL).
• Patient's refusal to participate in the study
• Alcohol and drug abuse.
• Peptic ulcer and duodenal ulcer in history.
• Obesity, body mass index (BMI) ≥40 kg / m2
• Intake of Trimetazidine MB and its analogues for 3 months. before inclusion in research.
• The presence of any disease that, according to the doctor, prevents the inclusion of the patient in the study.
• unable to understand study instructions
• with considerable illness in the musculoskeletal system or with physical disability, which complicates exercise training