Abstract
This study aimed to examine the factors that contribute to improvement of exercise tolerance in patients with heart failure (HF) and atrial fibrillation (AF) following cardiac rehabilitation. Our hypothesis is that parasympathetic values are important for recovering exercise tolerance in those patients. We included 84 consecutive patients with HF and AF (mean age: 69 ± 15 years, 80% men). All of the patients underwent a cardiopulmonary exercise test and had pre and post 5 month cardiac rehabilitation assessed. After 155 ± 11 days and 44 ± 8 sessions, 73 patients (86%) showed an increase in peak oxygen uptake (VO2) and VO2 at the anaerobic threshold. In univariate linear regression analysis, the % change in heart rate recovery, plasma B-type natriuretic peptide levels, resting heart rate, and the minute ventilation /carbon dioxide output slope were significantly related to that of peak VO2 (p < 0.01, p = 0.03, p = 0.02, p < 0.01, respectively). Stepwise multivariate linear regression analysis showed that the % change in heart rate recovery was independently related to that of peak VO2 (p < 0.05). Our results suggest that heart rate recovery is closely associated with recovery of exercise tolerance in patients with HF and AF after CR.
Highlights
Atrial fibrillation (AF) is a major cardiac rhythm disturbance that is frequently encountered in clinical practice
We found that heart rate recovery (HRR) is significantly associated with recovery of exercise tolerance in patients with heart failure (HF) and AF
Astolfi et al reported that increased HRR after the 6 min walk test was positively correlated with the 6 min walk test distance in patients after acute coronary syndrome [20]
Summary
Atrial fibrillation (AF) is a major cardiac rhythm disturbance that is frequently encountered in clinical practice. Even though AF is common in patients with underlying cardiac disease, it occurs in those without cardiac disease and its incidence is increasing yearly. Risk factors for developing AF include age, sex, obesity, and a low fitness level. Current management of AF mainly focuses on rate and rhythm control and reducing the risk of stroke, and its associated morbidity and mortality [1, 2]. Rate control therapy, including heart rate control and anticoagulant therapy, is unable to improve AF-derived exertional dyspnea. Development of new therapeutic strategies against AF, including
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