Rev. DERC (Online) 2020; 26(3): 148-152
Value of Exercise Testing in Permanent Atrial Fibrillation: Analysis of the Main Cardiovascular Variables
Abstract
Introduction:
Chronic atrial fibrillation (CAF) is the most common sustained arrhythmia in clinical practice associated with significant morbidity and mortality, however, there are few data in the literature on the analysis of functional capacity (FC) and cardiovascular variables (CV) obtained by exercise test (ET).
Objective:
To evaluate the efficacy and safety of ET in patients with CAF.
Methods:
Observational, retrospective study with patients with CAF who underwent ET. Were analyzed: FC in METs, hemodynamic behavior (RC and Δ PAS), coronary reserve (ST segment depression) and ventricular arrhythmias (AV). The protocols used were the modified Bruce or Bruce. It was also analyzed possible complications of ET. The probable etiology of the FAC was divided into: a) ischemic heart disease; b) valvar heart disease; c) dilated or hypertrophic myocardium; and d) idiopathic. All examinations were carried out while taking medications in common use (digital, beta-blocker, amiodarone or calcium channel antagonist).
Results:
Of the 88 patients (p), 62 (75%) were male and the average age was 62.9 (52 to 85 years). The estimated FC was 6.52 (+/- 2.6) METs, corresponding to poor aerobic fitness by the American Heart Association (AHA). 54 p (61.4%) presented an inotropic deficit with mean SBP of 31.4 mmHg. 34 p (38%) presented IVA, these being predominant in the FAC of ischemic and myocardial etiology. The maximum heart rate (HR) reached was 171.4 bpm, with exacerbated CR in 38% of patients, even when using drugs with negative chronotropic action. Significant chronotropic deficit (> 20%) occurred in 4 p (4.5%), and was associated with worse FC (<5 METs). The ST segment depression induced by effort or additional over 1.5 mm occurred in 46 p (52.8%), with no correlation with the ischemic heart disease of the FAC (p = 0565) by Fisher's exact test. There were no complications during or after the ET.
Conclusions:
In this study, ET was safe and useful in the clinical and hemodynamic evaluation of patients with CAF. In this patient population, we observed a lower functional capacity, depressed SBP response on exertion, and exacerbated HR. AV during ET were predominant in the FAC group of ischemic and myocardial etiology, and the ST segment depression was not related to patients with CAF with ischemic cardiomyopathy.
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