open access

Vol 13, No 6 (2006): Folia Cardiologica
Original articles
Published online: 2006-07-10
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Is mean heart rate a reliable predictor in the pharmacotherapy of patients with atrial fibrillation?

Michał Chudzik, Jerzy Krzysztof Wranicz, Iwona Cygankiewicz, Artur Klimczak, Jan Henryk Goch
Folia Cardiol 2006;13(6):473-479.

open access

Vol 13, No 6 (2006): Folia Cardiologica
Original articles
Published online: 2006-07-10

Abstract

Background: Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. A number of studies have demonstrated that heart rate control is the first line therapy for patients with AF. However, the correct ventricular rate and the parameters to be assessed are still open to question. The aim of the study was to evaluate whether mean heart rate (mHR) in 24-hour ECG Holter monitoring (HM) is useful parameter for the assessment of ventricular rhythm control in patients with AF. Additionally, we investigated whether other parameters such as episodes of tachy AF, irregularity of rhythm and the patient’s awareness of "palpitations" play an important role in controlling ventricular rate in AF.
Methods: Patients with chronic brady-tachy AF who had undergone VVI pacemaker implantation between 2 and 9 days earlier (a mean of 5.6 days previously) with optimal pharmacotherapy and mHR below 90 bpm were enrolled in this study. The studied parameters included mHR and the coefficient of irregularity (CI), based on HM and the percentage of fast ventricular rates (tachy AF episodes defined as a heart rate of > 120 bpm) derived from the pacemaker memory data. Symptoms such as "palpitations" were marked with a "+" over a period of 24 hours.
Results: Forty two patients (18 male, 24 female) with a mean age of 70.2 ± 8 years were included in the study. Their mHR in HM ranged from 48 bpm to 79 bpm, with a mean of 64.8 ± 7.5 bpm. Despite of a correct mHR, in 21 patients (50%) tachy AF episodes were observed. accounting for 1% to 8% beats, with a mean of 2.7 ± 2.02%. CI in HM varied from 0.9 to 0.33 with a mean of 0.23 ± 0.06. Significant irregularity, a CI above 0.2, together with a correct mHR was found in 73% patients. In the majority of patients with a low CI of < 0.2 (10 out of 11) there were no tachy AF episodes. A significant CI (> 0.2) was found in 10 out of 18 patients (56%) with a correct mHR and without tachy AF episodes. Palpitations were noted in 16 out of 21 patients with the correct mHR who had tachy AF episodes and 9 out of 10, also with the correct mHR, in whom no such episodes were recorded. All these patients had a significant ventricular rate irregularity with a CI of > 0.2.
Conclusions: The parameter of mHR derived from HM is not sufficient for controlling ventricular rate in the majority of patients with brady-tachy AF. It seems that evaluating tachyAF episodes, rhythm irregularity and symptoms experienced by the patient are also necessary for establishing for correct control of the heart rate in patients with AF. The CI could be superior to other parameters for the assessment of patients with AF who have correct mean heart rate.

Abstract

Background: Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. A number of studies have demonstrated that heart rate control is the first line therapy for patients with AF. However, the correct ventricular rate and the parameters to be assessed are still open to question. The aim of the study was to evaluate whether mean heart rate (mHR) in 24-hour ECG Holter monitoring (HM) is useful parameter for the assessment of ventricular rhythm control in patients with AF. Additionally, we investigated whether other parameters such as episodes of tachy AF, irregularity of rhythm and the patient’s awareness of "palpitations" play an important role in controlling ventricular rate in AF.
Methods: Patients with chronic brady-tachy AF who had undergone VVI pacemaker implantation between 2 and 9 days earlier (a mean of 5.6 days previously) with optimal pharmacotherapy and mHR below 90 bpm were enrolled in this study. The studied parameters included mHR and the coefficient of irregularity (CI), based on HM and the percentage of fast ventricular rates (tachy AF episodes defined as a heart rate of > 120 bpm) derived from the pacemaker memory data. Symptoms such as "palpitations" were marked with a "+" over a period of 24 hours.
Results: Forty two patients (18 male, 24 female) with a mean age of 70.2 ± 8 years were included in the study. Their mHR in HM ranged from 48 bpm to 79 bpm, with a mean of 64.8 ± 7.5 bpm. Despite of a correct mHR, in 21 patients (50%) tachy AF episodes were observed. accounting for 1% to 8% beats, with a mean of 2.7 ± 2.02%. CI in HM varied from 0.9 to 0.33 with a mean of 0.23 ± 0.06. Significant irregularity, a CI above 0.2, together with a correct mHR was found in 73% patients. In the majority of patients with a low CI of < 0.2 (10 out of 11) there were no tachy AF episodes. A significant CI (> 0.2) was found in 10 out of 18 patients (56%) with a correct mHR and without tachy AF episodes. Palpitations were noted in 16 out of 21 patients with the correct mHR who had tachy AF episodes and 9 out of 10, also with the correct mHR, in whom no such episodes were recorded. All these patients had a significant ventricular rate irregularity with a CI of > 0.2.
Conclusions: The parameter of mHR derived from HM is not sufficient for controlling ventricular rate in the majority of patients with brady-tachy AF. It seems that evaluating tachyAF episodes, rhythm irregularity and symptoms experienced by the patient are also necessary for establishing for correct control of the heart rate in patients with AF. The CI could be superior to other parameters for the assessment of patients with AF who have correct mean heart rate.
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Keywords

atrial fibrillation; heart rate irregularity; ventricular rate control

About this article
Title

Is mean heart rate a reliable predictor in the pharmacotherapy of patients with atrial fibrillation?

Journal

Cardiology Journal

Issue

Vol 13, No 6 (2006): Folia Cardiologica

Pages

473-479

Published online

2006-07-10

Bibliographic record

Folia Cardiol 2006;13(6):473-479.

Keywords

atrial fibrillation
heart rate irregularity
ventricular rate control

Authors

Michał Chudzik
Jerzy Krzysztof Wranicz
Iwona Cygankiewicz
Artur Klimczak
Jan Henryk Goch

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