Effects of Enhanced External Counterpulsation Combined With Cardiac Rehabilitation in Patients With Atrial Fibrillation

Atrial fibrillation (AF) is a common cardiac arrhythmia associated with impaired ventricular function, reduced exercise tolerance, and increased risk of cardiovascular events. While pharmacological treatments and catheter ablation are widely used, non-pharmacological interventions such as enhanced external counterpulsation (EECP) and cardiac rehabilitation (CR) may offer additional benefits for improving cardiac performance and quality of life. This prospective, single-center, randomized controlled trial aims to evaluate the effects of EECP combined with a structured cardiac rehabilitation program in patients with persistent or paroxysmal atrial fibrillation. A total of approximately 200 eligible participants will be randomized in a 1:1 ratio to receive either EECP plus cardiac rehabilitation (intervention group) or routine medical care (control group) for a defined treatment period. The cardiac rehabilitation program will include individualized exercise training, health education, risk factor management, and follow-up support. EECP will be performed according to standard protocols for cardiovascular patients. Primary outcome measures will include changes in left ventricular ejection fraction (LVEF) and six-minute walking distance (6MWD) from baseline to the end of the intervention. Secondary outcomes may include assessments of quality of life, symptoms, and biomarkers. Safety and feasibility will also be recorded. This study is expected to provide clinical evidence supporting the integration of EECP and cardiac rehabilitation as a non-invasive, multidimensional treatment approach in patients with atrial fibrillation.

Inclusion criteria

• Age between 40 and 80 years
• Diagnosed with persistent or paroxysmal atrial fibrillation, confirmed by ECG or Holter
• Stable medical condition and able to participate in cardiac rehabilitation and EECP therapy
• Provided written informed consent

Exclusion criteria

• Recent acute myocardial infarction, unstable angina, or decompensated heart failure within the past 4 weeks
• Severe valvular heart disease or left ventricular ejection fraction <30%
• Severe peripheral vascular disease or deep vein thrombosis
• Severe pulmonary disease or active infection
• History of bleeding disorders or contraindications to EECP
• Cognitive impairment or psychiatric condition affecting study participation
• Participation in another clinical trial within the past 3 months