Vol 59, No 9 (2003)
Other
Published online: 2005-12-12
Submitted: 2012-12-28
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Improvement in exercise performance after successful cardioversion in patients with persistent atrial fibrillation and symptoms of heart failure

Beata Wożakowska-Kapłon, Grzegorz Opolski
Kardiol Pol 2003;59(9):218-221.
Vol 59, No 9 (2003)
Other
Published online: 2005-12-12
Submitted: 2012-12-28

Abstract

Background: Loss of atrial systolic function as well as fast and irregular ventricular response result in the impairment of hemodynamic function in patients with atrial fibrillation (AF). AF is considered to be a less efficient cardiac rhythm than sinus rhythm (SR), and accounts for the symptoms of reduced exercise tolerance, such as fatigue, tiredness or dyspnoea. In more severe cases, the hemodynamic alterations can result in heart failure.
Aim: To assess exercise performance before and one month after cardioversion of persistent AF.
Methods: We studied 42 patients with mild to moderate clinically stable heart failure and persistent AF (median duration 7 months) with controlled ventricular rate. They underwent submaximal exercise testing 24 hours before cardioversion and one month after cardioversion. Exercise capacity was determined during symptom-limited exercise testing, according to a modified Bruce protocol with peak VO2 analysis.
Results: Thirty-five (83%) patients were successfully cardioverted to SR. One month after cardioversion 29 patients remained in SR (SR group) while 6 had recurrence of AF, and, together with patients with unsuccessful cardioversion, formed the AF group (n=13). Baseline patient characteristics did not differ between the SR and AF groups. Left ventricular ejection fraction (52.7±10.2% vs 56.5±9.6%, NS) and exercise tolerance (peak VO2 19.85±3.5 ml/min/kg vs 22.2±3,4 ml/kg/min, NS; and exercise duration 9.5±3.4 min vs 10.6±2.4 min; NS) were similar in both groups before cardioversion. Successful cardioversion resulted in a mean decrease in resting heart rate of 28 beats/minute (94.7±10.3 vs 66.7±9.7 beats/min, p<0.05), measured 30 days after cardioversion, and a significant improvement in exercise tolerance in the SR group: exercise duration increased from 9.5±3.4 min to 13.7±3.2 min, p<0.05; and peak oxygen consumption increased from 19.85±3.5 ml/min/kg to 32.2±3.6 ml/min/kg, p<0.05. No improvement was observed in the AF group.
Conclusions: Restoration of sinus rhythm in patients with persistent AF is associated with a significant improvement in exercise capacity one month after cardioversion.

Abstract

Background: Loss of atrial systolic function as well as fast and irregular ventricular response result in the impairment of hemodynamic function in patients with atrial fibrillation (AF). AF is considered to be a less efficient cardiac rhythm than sinus rhythm (SR), and accounts for the symptoms of reduced exercise tolerance, such as fatigue, tiredness or dyspnoea. In more severe cases, the hemodynamic alterations can result in heart failure.
Aim: To assess exercise performance before and one month after cardioversion of persistent AF.
Methods: We studied 42 patients with mild to moderate clinically stable heart failure and persistent AF (median duration 7 months) with controlled ventricular rate. They underwent submaximal exercise testing 24 hours before cardioversion and one month after cardioversion. Exercise capacity was determined during symptom-limited exercise testing, according to a modified Bruce protocol with peak VO2 analysis.
Results: Thirty-five (83%) patients were successfully cardioverted to SR. One month after cardioversion 29 patients remained in SR (SR group) while 6 had recurrence of AF, and, together with patients with unsuccessful cardioversion, formed the AF group (n=13). Baseline patient characteristics did not differ between the SR and AF groups. Left ventricular ejection fraction (52.7±10.2% vs 56.5±9.6%, NS) and exercise tolerance (peak VO2 19.85±3.5 ml/min/kg vs 22.2±3,4 ml/kg/min, NS; and exercise duration 9.5±3.4 min vs 10.6±2.4 min; NS) were similar in both groups before cardioversion. Successful cardioversion resulted in a mean decrease in resting heart rate of 28 beats/minute (94.7±10.3 vs 66.7±9.7 beats/min, p<0.05), measured 30 days after cardioversion, and a significant improvement in exercise tolerance in the SR group: exercise duration increased from 9.5±3.4 min to 13.7±3.2 min, p<0.05; and peak oxygen consumption increased from 19.85±3.5 ml/min/kg to 32.2±3.6 ml/min/kg, p<0.05. No improvement was observed in the AF group.
Conclusions: Restoration of sinus rhythm in patients with persistent AF is associated with a significant improvement in exercise capacity one month after cardioversion.
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Keywords

atrial fibrillation - cardioversion - exercise testing

About this article
Title

Improvement in exercise performance after successful cardioversion in patients with persistent atrial fibrillation and symptoms of heart failure

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 59, No 9 (2003)

Pages

218-221

Published online

2005-12-12

Bibliographic record

Kardiol Pol 2003;59(9):218-221.

Keywords

atrial fibrillation - cardioversion - exercise testing

Authors

Beata Wożakowska-Kapłon
Grzegorz Opolski

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