{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T14:10:25Z","timestamp":1740147025635,"version":"3.37.3"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008497","name":"Boston Scientific Corporation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008497","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Atrial fibrillation (AF) is associated with significant morbidity\/mortality. AF-ablation is an increasingly used treatment. Currently, first-time AF-ablation success is 40\u201380% at 1-year, depending on individual factors. There is growing evidence for improved outcomes through management of AF risk-factors\/comorbidities via patient education\/exercise-rehabilitation. There are no studies assessing combined prehabilitation\/rehabilitation in this cohort. The aim of this randomised controlled trial is to assess efficacy of comprehensive prehabilitation\/rehabilitation and combining supervised exercise-training with AF risk-factor modification\/education compared with standard care in people undergoing first-time AF ablation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This single-centre pragmatic randomised controlled trial will recruit 106 adults with paroxysmal\/persistent AF listed for first-time AF-ablation. Participants will be randomised 1:1 to cardiac prehabilitation\/rehabilitation\/education (CREED AF) intervention or standard care. Both groups will undergo AF-ablation at 8-weeks post-randomisation as per usual care. The CREED AF intervention will involve 6-weeks of prehabilitation (before AF-ablation) followed by 6-weeks rehabilitation (after AF-ablation) consisting of risk factor education\/modification and supervised exercise training. Standard care will include a single 30-minute session of risk-factor education. Outcomes will be measured at baseline, 10-weeks and 12-months post AF-ablation, by researchers blinded to treatment allocation. The primary outcome is cardiorespiratory-fitness (peak oxygen uptake, VO<jats:sub>2peak<\/jats:sub>) assessed using cardiopulmonary exercise testing (CPET) at 10-weeks post-ablation. Secondary outcomes include health-related quality of life, AF recurrence\/burden assessed by 7-day Holter-monitor, requirement for repeat AF-ablation, study defined major adverse cardiovascular events, and cost-effectiveness (incremental cost per quality-adjusted life year (QALY)).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study will assess clinical-efficacy\/cost-effectiveness of comprehensive prehabilitation\/rehabilitation\/patient-education for people undergoing first time AF-ablation. Results will inform clinical care and design of future multi-centre clinical trials.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p><jats:bold>URL:<\/jats:bold> <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\/\" xlink:type=\"simple\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>; Unique identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT06042231\" xlink:type=\"simple\">NCT06042231<\/jats:ext-link>.Date registered: September 18, 2023.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0310951","type":"journal-article","created":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T17:32:14Z","timestamp":1727976734000},"page":"e0310951","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiac prehabilitation, rehabilitation and education in first-time atrial fibrillation (AF) ablation (CREED AF): Study protocol for a randomised controlled 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