The effect of atrial fibrillation and the ventricular rate control on exercise capacity

Abstract

BACKGROUND: Atrial fibrillation (AF) is a common cardiac arrhythmia, affecting approximately 1.5 million patients in the United States. HYPOTHESIS: This study was designed to determine the effect of AF and the ventricular rate control during AF on cardiovascular performance as measured by exercise endurance on a standard Bruce protocol. METHODS: Sixty-three patients with AF who underwent exercise stress testing during both sinus rhythm and AF were analyzed. Heart rate, blood pressure, heart rate acceleration, exercise duration, and left ventricular (LV) systolic function were measured. RESULTS: Atrial fibrillation resulted in a small but statistically significant decrease in exercise endurance (426 +/- 180 vs. 402 +/- 168 s, p < 0.05). The drop in exercise tolerance was consistent regardless of the underlying heart condition or adequate ventricular rate control during AF. Heart rate in AF was consistently faster than in sinus rhythm, at rest, and at peak exercise (63 vs. 79 beats/min and 125 vs. 149 beats/min, respectively, p < 0.001). CONCLUSION: Our analyses indicated that (1) the loss of atrioventricular synchrony had minimal effect on cardiovascular performance in patients with preserved LV function, (2) the decrease in cardiovascular performance was related to loss of atrioventricular synchrony but not to underlying heart disease or ventricular rate control, and (3) compensation for the loss of the atrial contribution was provided by consistently faster heart rate during AF.