P6059Echocardiography parameters, respiratory eficiency, and quality of life in patients with permanent atrial fibrillation and heart failure: effect of exercise training. A randomized controlled trial

Abstract

Introduction: Permanent atrial fibrillation is an arrhythmia that affects approxi‐mately 20% of patients with heart failure (HF). These cardiovascular epidemics can generate impairments on cardiac function, leading to functional decline and quality of life, with a negative impact on morbidity and mortality. The benefits of exercise training (ET) under these conditions have been demonstrated by numer‐ous studies. However, there are still a few studies on the benefits of ET in AFp associated with HF. Purpose: The aim of this study was to verified the effect of ET on echocardio‐graphic parameters, respiratory efficiency and quality of life in patients with HF and AFp. Methods: 32 men, age 53±6 years, with HF and Afp were randomly allocated to cardiac exercise training group (n=16) or control group (n=16). The left atrial dimension (LAD), left atrial volume (LAV), left ventricular mass (LVM), left ven‐tricular end‐systolic volume (LVSV), left ventricular end‐diastolic volume (LVDV) and left ventricular ejection fraction (LVEF) were evaluated by two‐dimensional doppler echocardiography. The maximal oxygen consumption (VO2máx) and minute ventilation of the production of carbon dioxide (VE/VCO2 slope) was eval‐uated by cardiopulmonary exercise testing on cycloergometer. The quality of life was evaluated by Minnesota questionnaire. Exercise training was performed in 60‐minute sessions three times a week for 12 weeks. The exercise protocol con‐sisted of 5 minutes of warm‐up, 40 minutes of aerobic exercise on a cycloergome‐ter, 15 minutes of resistance exercises and 5 minutes of calm back. The control group was advised to maintain as usual activities. Results: Baseline characteristics were not different between groups. After 12 weeks, the exercise training group significantly modified the echocardiographic parameters: decreasing the LAD (from 53.4±3.2 to 46.8±3.8 mm, P<0.001), LAV (from 152,2±17,1 to 138,1±13,0 ml, P<0.001), LVM (from 266.4±29.1 to 211.3±31.2 g, P<0.001), LVSV (from 135.6±4.4 to 124.4±5.6 ml, P<0.001) and LVDV (from 194.2±9.1 to 177.2±8.1 ml, P<0.001), and increasing LVEF (from 33.1±3.6% to 39.1±3.2%, P<0.001). Exercise training also increased VO2máx (from 15.3±2.8 to 19.0±2.5 ml kg min$sup$‐1$/sup$, P<0.001), decreased VE/VCO2 slope (from 38.9±4.9 to 32.1±3.0, P<0.001), and decreased the overall quality of life score (from 40.4±5.0 to 26.2±15.9, P<0.002). There were no changes in the con‐trol group during the protocol, except the increasing on VE/VCO2 slope (from 39.2±6.4 to 41.1±5.9, P<0.003). Six patients, three in each group, did not complete the study period due to two withdrawals and one death in each group. Conclusion: Exercise training after 12 weeks was safe strategy that improves cardiac structure and function, respiratory eficiency and quality of life of patients with AFp associated with HF. Despite the need for future studies, such findings support the importance of intervention with exercise in treatment of the arrhyth‐mia. Funding Acknowledgements: São Paulo Research Foundation‐FAPESP.