Permanent atrial fibrillation affects exercise capacity in chronic heart failure patients.
OBJECTIVE
The influence of permanent atrial fibrillation on exercise tolerance and cardio-respiratory function during exercise in heart failure (HF) is unknown.


RESULTS
We retrospectively compared the results of 942 cardiopulmonary exercise tests, performed consecutively at seven Italian laboratories, in HF patients with atrial fibrillation (n = 180) and sinus rhythm (n = 762). By multivariable logistic regression analysis, peak VO(2) (OR 0.376, 95% CI 0.240-0.588, P < 0.0001), O(2)pulse (VO(2)/heart rate, HR) (OR 0.236, 95% CI 0.152-0.366, P < 0.0001), VCO(2) (OR 3.97, 95% CI 2.163-7.287, P < 0.0001), and ventilation (OR 1.38, 95% CI 1.045-1.821, P = 0.0231) were independently associated with atrial fibrillation. Anaerobic threshold (AT) was identified in 132 of 180 (73%) atrial fibrillation and in 649 of 762 (85%) sinus rhythm patients (P = 0.0002). By multivariable logistic regression analysis, only peak VO(2) (OR 0.214, 95% CI 0.155-0.296, P < 0.0001) was independently associated with unidentified AT. At AT, atrial fibrillation HF patients had higher HR (P < 0.0001) and higher VO(2) (P < 0.001) compared with sinus rhythm HF patients. Among AT variables, by multivariable logistic regression analysis, only HR was an independent predictor of atrial fibrillation.


CONCLUSIONS
In HF patients with permanent atrial fibrillation, exercise performance is reduced as reflected by reduced peak VO(2). The finding of unidentified AT is associated with a poor performance. In atrial fibrillation patients, VO(2) is higher at AT whereas lower at peak. This last observation raises uncertainties about the use of AT data to define performance and prognosis of HF patients with atrial fibrillation.
Agostoni
Piergiuseppe
P
Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia, Università di Milano, via Parea 4, 20138 Milano, Italy. piergiuseppe.agostoni@unimi.it
Emdin
Michele
M
Corrà
Ugo
U
Veglia
Fabrizio
F
Magrì
Damiano
D
Tedesco
Calogero C
CC
Berton
Emanuela
E
Passino
Claudio
C
Bertella
Erika
E
Re
Federica
F
Mezzani
Alessandro
A
Belardinelli
Romualdo
R
Colombo
Chiara
C
La Gioia
Rocco
R
Vicenzi
Marco
M
Giannoni
Alberto
A
Scrutinio
Domenico
D
Giannuzzi
Pantaleo
P
Tondo
Claudio
C
Di Lenarda
Andrea
A
Sinagra
Gianfranco
G
Piepoli
Massimo F
MF
Guazzi
Marco
M
D015308:Anaerobic Threshold / Q000502:physiology*; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology*; D002908:Chronic Disease; D015331:Cohort Studies; D018450:Disease Progression; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome