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30 reviewsBACKGROUND Atrial fibrillation (AF) increases cardiovascular risks and reduces quality of life. Although impairedphysical activity has correlated with incident AF, the impacts of exercise capacity and blood pressure changes duringexercise on AF development remain unclear.OBJECTIVES The purpose of this study was to evaluate the association between exercise capacity and AF incidenceand its effects on major adverse cardiovascular events (MACE).METHODS We conducted a retrospective analysis using a prospectively maintained administrative database of patientsundergoing exercise treadmill testing between 2003 and 2012. Blood pressure measurements at baseline, peak exercise,and recovery were recorded. Participants were followed for new-onset AF and MACE.RESULTS Among 15,450 subjects (median follow-up: 9.1 years; IQR: 7.0-11.5 years), 515 (3.3%) developed AF. PeakMETS (pMETs) independently predicted a lower risk of incident AF (HR: 0.92; 95% CI: 0.88-0.97), after adjusting forconfounders. Cubic spline analysis revealed a continuous inverse association between pMETs and incident AF. This association was stronger in older adults and those without chronotropic incompetence. Although incident AF increased therisks of ischemic stroke and MACE, higher pMETs independently reduced the risks of ischemic stroke (HR: 0.88; 95% CI:0.83-0.94) and MACE (HR: 0.86; 95% CI: 0.84-0.88), even after adjusting for incident AF as a time-dependent variable.Additionally, diastolic blood pressure during recovery independently also correlated with incident AF and ischemic stroke.CONCLUSIONS Higher exercise capacity was associated with a lower AF incidence and reduced risks of ischemic strokeand MACE, reinforcing the prognostic value of cardiorespiratory fitness in AF prevention and cardiovascular riskreduction. (JACC Asia. 2025;■:■–■) © 2025 The Authors. Published by Elsevier on behalf of the American College ofCardiology Foundation. This