INFLUENCE OF THE HEART RATE ON THE EXERCISE CAPACITY IN PATIENTS WITH A PERMANENT ATRIAL FIBRILLATION NON-VALVULAR ETIOLOGY
DOI:
https://doi.org/10.11603/1811-2471.2017.v1.i3.8175Keywords:
permanent atrial fibrillation, heart rate control, exercise capacity, treadmill test, 6-minute walk test.Abstract
The purpose of the study – estimate the dynamic changes of exercise capacity in patients with permanent atrial fibrillation non-valvular etiology during treatment with β-blockers (BB), determination the critical value of the heart rate as a negative dynamic predictor of the patients functional state during 6 month monitoring, identification the preference for one of the HR control strategies.
Material and methods. 30 patients were included in this study. The duration of observation was 238.3±17.0 days, the design consisted in 3 visits. Titration of the BB dose lasted 67.7±10.3 days (the interval between 1 and 2 visits). Reception of the maximum or maximum tolerable dose of BB lasted 170.6±17.7 days (the interval between 2 and 3 visits). Paired exercise testing – treadmill test (TT) test and 6-minute walk test (6MWT) were performed during 2 and 3 visits.
Results. During follow-up period significantly increased submaximal systolic blood pressure, inotropic reserve, reserve double product (DP) and reduced DP index. The performed correlation analysis revealed a relationship between the DP index with the mean daily HR value according to 24 h Holter ECG. With strict heart rate control after 6 months significantly decreased the 6MWT distance. When comparing both strategies strict control showed a significant advantage for reducing resting heart rate, heart rate at submaximal exercise testing (visits 2 and 3), resting DP, DP index, as well as increased chronotropic reserve (2 visit).
Conclusions. There was an improvement in exercise capacity after 6 months with the treatment of BB in patients with PAF non-valvular etiology. Predictor of its decrease is the median daily heart rate >90.5 beats/min, recorded during the Holter ECG. Strict heart rate control has an advantage over lenient on improving the patients functional state and their outcomes.
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