Abstract 13075: Hemodynamic Estimation of Personalized Initial Target Heart Rate in Patients With Atrial Fibrillation With Rapid Ventricular Response

Abstract

Introduction: Rate control in atrial fibrillation (AF) has played a pivot role in clinical setting even though recent advances in rhythm control. There are few evidences for target heart rate in either acute or chronic situations. Hypothesis: This study tried to estimate personalized initial target heart rate based on hemodynamic assessment in patient with AF with rapid ventricular response. Methods: A total of 72 patients with AF were included. From the equation between preceding RR interval and left ventricular peak ejection velocity adjusted by pre-preceding RR interval, the relationship between cardiac performance representing cardiac output and heart rate was calculated, and heart rate showing maximal cardiac performance (HRmax) was obtained (Left Figure). Results: Mean HRmax was 126±21.8/min (from 75/min to 188/min). Three-fourth patients had HRmax >120/minute (Right Figure). The relationship between Vpe and preceding RR interval showed two types, biphasic or monophasic resulting in similar patterns between cardiac performance and heart rate (Left Figure). HRmax <100/min was found in 7 patients in whom left ventricular dilatation, dysfunction, and/or aortic regurgitation were observed (Left Figure C). Lower HRmax was independently associated with larger aorta size (r=0.48, p<0.001), the absence of mitral regurgitation (r=0.43, p<0.005), prescription of angiotensin converting enzyme inhibitor or angiotensin receptor blocker (r=0.39, p=0.001), and a history of heart failure (r=0.21, p=0.019). Conclusions: In most AF patients, hemodynamic approach suggested that tachycardia of 120/min or more is tolerable. The method of this study may be useful to deliver individually designed management by identifying patient that strict rate control is mandatory. In other patients, management of underlying causes for tachycardia is enough without medications for mechanical heart rate control to avoid adverse effects without clinical benefits.