Presenting in atrial fibrillation rather than sinus rhythm was associated with failure to augment left atrial function during exercise and reduced VO2Peak (18.4 vs 22.5 ml/kg/min, p=0.003).
Observational (n=105)
Does presenting in sinus rhythm compared to atrial fibrillation improve left atrial mechanical response to exercise and exercise tolerance in patients with symptomatic AF and preserved LVEF?
In patients with symptomatic AF and preserved LVEF, maintaining sinus rhythm is associated with preserved left atrial functional augmentation during exercise and better exercise tolerance compared to being in AF.
Absolute Event Rate: 18.4% vs 22.5%
p-value: p=0.003
Left atrial (LA) function contributes to the augmentation of cardiac output during exercise. However, LA response to exercise in patients with atrial fibrillation (AF) is unknown. We explored the LA mechanical response to exercise and the association between LA dysfunction and exercise intolerance. We recruited consecutive patients with symptomatic AF and preserved left ventricular ejection fraction (LVEF). Participants underwent exercise echocardiography and cardiopulmonary exercise testing (CPET). Two-dimensional and speckle-tracking echocardiography were performed to assess LA function at rest and during exercise. Participants were grouped according to presenting rhythm (AF vs sinus rhythm). The relationship between LA function and cardiorespiratory fitness in patients maintaining SR was assessed using linear regression. Of 177 consecutive symptomatic AF patients awaiting AF ablation, 105 met inclusion criteria; 31 (29.5 %) presented in AF whilst 74 (70.5 %) presented in SR. Patients in SR augmented LA function from rest to exercise, increasing LA emptying fraction (LAEF) and LA reservoir strain. In contrast, patients in AF demonstrated reduced LAEF and reservoir strain at rest, with failure to augment either parameter during exercise. This was associated with reduced VO2Peak compared to those in SR (18.4 ± 5.6 vs 22.5 ± 7.7 ml/kg/min, p = 0.003). In patients maintaining SR, LAEF and reservoir strain at rest and during exercise were associated with VO2Peak, independent of LV function. The maintenance of SR in patients with AF is associated with greater LA reservoir function at rest and greater augmentation with exercise compared to patients in AF. In patients in SR, reduced LA function is associated with reduced exercise tolerance, independent of LV function.
Ariyaratnam et al. (Thu,) conducted a observational in Symptomatic atrial fibrillation with preserved LVEF (n=105). Presenting rhythm: Atrial fibrillation (AF) vs. Presenting rhythm: Sinus rhythm (SR) was evaluated on VO2Peak (ml/kg/min) (p=0.003). Presenting in atrial fibrillation rather than sinus rhythm was associated with failure to augment left atrial function during exercise and reduced VO2Peak (18.4 vs 22.5 ml/kg/min, p=0.003).