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European Heart Journal Advance Access published online on August 5, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn361
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Permanent atrial fibrillation affects exercise capacity in chronic heart failure patients

Piergiuseppe Agostoni1,2,*, Michele Emdin3, Ugo Corrà4, Fabrizio Veglia1, Damiano Magrì1, Calogero C. Tedesco1, Emanuela Berton5, Claudio Passino3, Erika Bertella1, Federica Re6, Alessandro Mezzani4, Romualdo Belardinelli7, Chiara Colombo1, Rocco La Gioia8, Marco Vicenzi9, Alberto Giannoni3, Domenico Scrutinio8, Pantaleo Giannuzzi4, Claudio Tondo6, Andrea Di Lenarda5, Gianfranco Sinagra5, Massimo F. Piepoli10 and Marco Guazzi9

1 Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia, Università di Milano, via Parea 4, 20138 Milano, Italy
2 Division of Respiratory Disease and Critical Care Medicine, University of Washington, Seattle, WA, USA
3 Istituto di Fisiologia Clinica, CNR, Pisa, Italy
4 Divisione di Cardiologia, Laboratory for the analysis of cardiorespiratory signals, IRCCS, Fondazione S. Maugeri, Veruno, Novara, Italy
5 Cardiovascular Department, ‘Ospedali Riuniti’ and University, Trieste, Italy
6 Cardiology Division, Cardiac Arrhythmias and Heart Failure Unit, San Camillo Forlanini Hospital/Catholic University of Sacred Heart, Roma, Italy
7 Divisione di Cardiologia, Ospedale Lancisi, Ancona, Italy
8 Division of Cardiology and Cardiac Rehabilitation, IRCCS, Fondazione S. Maugeri, Cassano Murge, Bari, Italy
9 Divisione di Cardiologia, Unità Operativa Cardiopolmonare, Ospedale San Paolo, Milano, Italy
10 Heart Failure Unit, Cardiac Unit, Polichirurgico G. da Saliceto Hospital, Cantone del Cristo, Piacenza, Italy

Received 28 February 2008; revised 10 July 2008; accepted 17 July 2008.

* Corresponding author. Tel: +39 02 58002299, Fax: +39 02 58002283, Email: piergiuseppe.agostoni{at}unimi.it

Aims: The influence of permanent atrial fibrillation on exercise tolerance and cardio-respiratory function during exercise in heart failure (HF) is unknown.

Methods and results: We retrospectively compared the results of 942 cardiopulmonary exercise tests, performed consecutively at seven Italian laboratories, in HF patients with atrial fibrillation (n = 180) and sinus rhythm (n = 762). By multivariable logistic regression analysis, peak VO2 (OR 0.376, 95% CI 0.240–0.588, P < 0.0001), O2pulse (VO2/heart rate, HR) (OR 0.236, 95% CI 0.152–0.366, P < 0.0001), VCO2 (OR 3.97, 95% CI 2.163–7.287, P < 0.0001), and ventilation (OR 1.38, 95% CI 1.045–1.821, P = 0.0231) were independently associated with atrial fibrillation. Anaerobic threshold (AT) was identified in 132 of 180 (73%) atrial fibrillation and in 649 of 762 (85%) sinus rhythm patients (P = 0.0002). By multivariable logistic regression analysis, only peak VO2 (OR 0.214, 95% CI 0.155–0.296, P < 0.0001) was independently associated with unidentified AT. At AT, atrial fibrillation HF patients had higher HR (P < 0.0001) and higher VO2 (P < 0.001) compared with sinus rhythm HF patients. Among AT variables, by multivariable logistic regression analysis, only HR was an independent predictor of atrial fibrillation.

Conclusion: In HF patients with permanent atrial fibrillation, exercise performance is reduced as reflected by reduced peak VO2. The finding of unidentified AT is associated with a poor performance. In atrial fibrillation patients, VO2 is higher at AT whereas lower at peak. This last observation raises uncertainties about the use of AT data to define performance and prognosis of HF patients with atrial fibrillation.

Key Words: Heart failure • Atrial fibrillation • Cardiopulmonary exercise testing • Anaerobic threshold


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