Differences in Heart Rate Response and Recovery After 6-Minute Walk Test Between Patients With Atrial Fibrillation and in Sinus Rhythm
Differences in Heart Rate Response and Recovery After 6-Minute Walk Test Between Patients With Atrial Fibrillation and in Sinus Rhythm
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房颤患者和窦性心律患者 6 分钟步行测试后心率反应和恢复的差异
DOI：
10.1016/j.amjcard.2018.04.048
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发表时间：
2018
影响因子：
2.8
通讯作者：
Hai Su
中科院分区：
文献类型：
--
作者：
Luo Xiao;Xiong Qinmei;Xu Jingsong;Hong Kui;Peng Qiang;Li Juxiang;Cheng Xiaoshu;Lip Gregory Y H;Hai Su
长期心率（HR）控制是慢性心房颤动（AF）患者的一种管理策略。然而，房颤患者的最佳目标心率尚有争议。我们的目的是研究房颤患者在休息时、6分钟步行试验（6MWT）期间和之后的心率，并与有窦性心律（SR）的对照组进行比较。招募连续匹配的AF （n = 186）或SR （n = 172）患者，进行6MWT。记录静息时、6MWT时和恢复期的hr。根据静息心率分为<80次/分、80 ~ 89次/分、90 ~ 99次/分、100 ~ 109次/分、≥110次/分5个亚组。AF组和SR组静止时基线心率无统计学差异（p = 0.30）。整体AF患者的运动HR增加百分比明显高于SR患者（40±15% vs 14±7%,p <0.001）。即使静止时平均基线心率相似，5个AF亚组与各自的SR亚组相比，平均运动心率、最大运动心率和最大运动心率的增加百分比均显著高于SR亚组，尤其是静止心率为bb0 90次/分的亚组。与SR患者不同的是，4个AF亚组在6MWT后第5分钟心率低于80次/分钟时没有恢复到休息水平。综上所示，AF患者在6MWT期间心率过度升高，且6MWT后心率恢复延迟，尤其是当静息心率为bb0 ~ 90次/min时。房颤患者静息时的最佳初始HR应小于90次/分。
Long-term heart rate (HR) control is a management strategy for patients with chronic atrial fibrillation (AF). Nevertheless, the optimal target HR of AF patients is debatable. Our aim was to study HR at rest, during, and after a 6-minute walk test (6MWT) in AF patients, compared with controls with sinus rhythm (SR). Consecutive matched patients with AF (n = 186) or SR (n = 172) were recruited, and 6MWT was performed. HRs at rest, during 6MWT, and recovery periods were recorded. All subjects were divided into 5 subgroups (<80 beats/min, 80 to 89 beats/min, 90 to 99 beats/min, 100 to 109 beats/min, and ≥110 beats/min) according to the HR at rest. No statistical difference was observed in baseline HR at rest, between AF and SR groups (p = 0.30). The exercise HR increase percentage was significantly higher in overall AF patients compared with those in SR (40 ± 15% vs 14 ± 7%, p <0.001). Even with similar mean baseline HRs at rest, the 5 AF subgroups all showed significantly higher mean exercise HR, maximal exercise HR, and maximal exercise HR increase percentage compared with their respective SR subgroups, especially the subgroups with HR at rest >90 beats/min. Unlike the SR patients, the 4 AF subgroups with HR >80 beats/min at the fifth minute after 6MWT did not recover to at rest levels. In conclusion, HR increased excessively during 6MWT and HR recovery was delayed after 6MWT in AF patients, especially when HR at rest is >90 beats/min. The optimal initial HR at rest for AF patients should perhaps be <90 beats/min.