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Heart Rate Control in Patients With Atrial Fibrillation Referred for Exercise Testing

      Clinical practice guidelines for patients with atrial fibrillation (AF) recommended a heart rate (HR) of 60 to 80 beats/min at rest and 90 to 115 at moderate exercise. The degree to which HR control at rest and with exercise in patients with AF complies with these recommendations is unknown. HR at rest and at peak exercise was retrospectively examined in 1,097 consecutive patients with AF referred for exercise myocardial perfusion imaging. In a subgroup of 195 patients, HR was also measured at an intermediate “moderate” level. Median HR at rest was 80 beats/min, at the upper end of the recommended range of 60 to 80. Only patients administered a β blocker (BB; 31%) had lower (p <0.001) median HRs at rest. Median HR at moderate exercise was 128 beats/min, higher than the range of 90 to 115 recommended by the guidelines. Only patients administered a BB had significantly reduced HRs (p <0.003) at moderate exercise. Median peak exercise HR was 147 beats/min. Forty-five percent of patients exceeded their age-predicted maximal HR. Patients administered BBs were significantly less likely (p <0.01) to exceed their age-predicted maximal HR. In conclusion, in patients with AF, HR control at rest and during exercise often did not comply with guideline recommendations. Regimens including a BB were more effective in achieving HR control.
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      References

        • Antman E.M.
        Atrial fibrillation and flutter: maintaining stability of sinus rhythm versus ventricular rate control.
        J Cardiovasc Electrophysiol. 1995; 6: 962-971
        • Wyse D.G.
        • Waldo A.L.
        • DiMarco J.P.
        • Domanski M.J.
        • Rosenberg Y.
        • Schron E.B.
        • Kellen J.C.
        • Greene H.L.
        • Mickel M.C.
        • Dalquist J.E.
        • Corley S.D.
        A comparison of rate control and rhythm control in patients with atrial fibrillation.
        N Engl J Med. 2002; 347: 1825-1833
        • Van Gelder I.C.
        • Hagens V.E.
        • Bosker H.A.
        • Kingma J.H.
        • Kamp O.
        • Kingma T.
        • Said S.A.
        • Darmanata J.I.
        • Timmermans A.J.
        • Tijssen J.G.
        • Crijns H.J.
        A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation.
        N Engl J Med. 2002; 347: 1834-1840
        • Atwood J.E.
        • Sullivan M.
        • Forbes S.
        • Myers J.
        • Pewen W.
        • Olson H.G.
        • Froelicher V.F.
        Effect of beta-adrenergic blockade on exercise performance in patients with chronic atrial fibrillation.
        J Am Coll Cardiol. 1987; 10: 314-320
        • Steinberg J.S.
        • Katz R.J.
        • Bren G.B.
        • Buff L.A.
        • Varghese P.J.
        Efficacy of oral diltiazem to control ventricular response in chronic atrial fibrillation at rest and during exercise.
        J Am Coll Cardiol. 1987; 9: 405-411
        • Lundstrom T.
        • Ryden L.
        Ventricular rate control and exercise performance in chronic atrial fibrillation: effects of diltiazem and verapamil.
        J Am Coll Cardiol. 1990; 16: 86-90
        • Dahlstrom C.G.
        • Edvardsson N.
        • Nasheng C.
        • Olsson S.B.
        Effects of diltiazem, propranolol, and their combination in the control of atrial fibrillation.
        Clin Cardiol. 1992; 15: 280-284
        • Rawles J.M.
        What is meant by a “controlled” ventricular rate in atrial fibrillation?.
        Br Heart J. 1990; 63: 157-161
        • McNamara R.L.
        • Tamariz L.J.
        • Segal J.B.
        • Bass E.B.
        Management of atrial fibrillation: review of the evidence for the role of pharmacologic therapy, electrical cardioversion, and echocardiography.
        Ann Intern Med. 2003; 139: 1018-1033
        • Fuster V.
        • Ryden L.E.
        • Cannom D.S.
        • Crijns H.J.
        • Curtis A.B.
        • Ellenbogen K.A.
        • Halperin J.L.
        • Le Heuzey J.Y.
        • Kay G.N.
        • Lowe J.E.
        • et al.
        ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.
        Circulation. 2006; 114: e257-e354
        • Stafford R.S.
        • Robson D.C.
        • Misra B.
        • Ruskin J.
        • Singer D.E.
        Rate control and sinus rhythm maintenance in atrial fibrillation: national trends in medication use, 1980–1996.
        Arch Intern Med. 1998; 158: 2144-2148
        • Matsuda M.
        • Matsuda Y.
        • Yamagishi T.
        • Takahashi T.
        • Haraguchi M.
        • Tada T.
        • Kusukawa R.
        Effects of digoxin, propranolol, and verapamil on exercise in patients with chronic isolated atrial fibrillation.
        Cardiovasc Res. 1991; 25: 453-457
        • Zarowitz B.J.
        • Gheorghiade M.
        Optimal heart rate control for patients with chronic atrial fibrillation: are pharmacologic choices truly changing?.
        Am Heart J. 1992; 123: 1401-1403
        • Koh K.K.
        • Kwon K.S.
        • Park H.B.
        • Baik S.H.
        • Park S.J.
        • Lee K.H.
        • Kim E.J.
        • Kim S.H.
        • Cho S.K.
        • Kim S.S.
        Efficacy and safety of digoxin alone and in combination with low-dose diltiazem or betaxolol to control ventricular rate in chronic atrial fibrillation.
        Am J Cardiol. 1995; 75: 88-90
        • Gardner M.J.
        • Gilbert M.
        Heart rate control in patients with atrial fibrillation.
        Can J Cardiol. 1996; 12: 21A-23A
        • Farshi R.
        • Kistner D.
        • Sarma J.S.
        • Longmate J.A.
        • Singh B.N.
        Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens.
        J Am Coll Cardiol. 1999; 33: 304-310
        • Olshansky B.
        • Rosenfeld L.E.
        • Warner A.L.
        • Solomon A.J.
        • O'Neill G.
        • Sharma A.
        • Platia E.
        • Feld G.K.
        • Akiyama T.
        • Brodsky M.A.
        • Greene H.L.
        • Investigators A
        The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study: approaches to control rate in atrial fibrillation [comment].
        J Am Coll Cardiol. 2004; 43: 1201-1208