Chang Jinna, Du Qian, Liu Yuting, Li Dujuan, Zhou Haofeng, Liao Yingxue, Zhu Junshuo, Bai Bingqing, Liu Xiangyang, Ma Huan
Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong, 510080, China.
Department of Cardiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, 510240, China.
BMC Cardiovasc Disord. 2025 Jul 9;25(1):501. doi: 10.1186/s12872-025-04961-9.
Rate control is a primary treatment approach for managing atrial fibrillation (AF). However, a unified standard for the optimal level of control remains unestablished. This study aimed to investigate the impact of strict versus lenient heart rate control strategies on exercise capacity in patients with AF by assessing cardiopulmonary exercise test (CPET) results.
A total of 693 patients with AF were included in this study. The patients were categorized into three groups on the basis of their resting heart rate: strict rate control (resting heart rate < 80 beats per minute and heart rate during moderate exercise < 110 beats per minute), lenient rate control (resting heart rate < 110 beats per minute), and uncontrolled rate (resting heart rate ≥ 110 beats per minute. CPET indicators were compared across the different rate control strategies, and trend analyses were conducted to explore whether there was a correlation between heart rate control and exercise capacity.
Significant differences in the maximum load, respiratory exchange ratio (RER), peak oxygen uptake (peak VO), peak oxygen pulse, and ventilatory equivalent (VE/VCO) at the anaerobic threshold were detected among the groups in the strict control, lenient control, and uncontrolled groups (all p < 0,05). However, no significant differences were detected in the anaerobic threshold or ventilation parameters among these groups. Trend analyses indicated that stricter heart rate control was associated with significant increases in maximum workload, peak VO, peak oxygen pulse, and ventilatory equivalent.
In patients with AF, strict heart rate control may enhance exercise capacity, suggesting the importance of effective heart rate management strategies.
心率控制是治疗心房颤动（AF）的主要方法。然而，最佳控制水平的统一标准尚未确立。本研究旨在通过评估心肺运动试验（CPET）结果，探讨严格与宽松心率控制策略对AF患者运动能力的影响。
本研究共纳入693例AF患者。根据静息心率将患者分为三组：严格心率控制组（静息心率<80次/分钟，中度运动时心率<110次/分钟）、宽松心率控制组（静息心率<110次/分钟）和未控制心率组（静息心率≥110次/分钟）。比较不同心率控制策略下的CPET指标，并进行趋势分析，以探讨心率控制与运动能力之间是否存在相关性。
严格控制组、宽松控制组和未控制组之间在最大负荷、呼吸交换率（RER）、峰值摄氧量（peak VO）、峰值氧脉搏和无氧阈时的通气当量（VE/VCO）方面存在显著差异（所有p<0.05）。然而，这些组之间在无氧阈或通气参数方面未检测到显著差异。趋势分析表明，更严格的心率控制与最大工作量、peak VO、峰值氧脉搏和通气当量的显著增加相关。
在AF患者中，严格的心率控制可能会提高运动能力，提示有效心率管理策略的重要性。
