Guidelines' criteria for rate control in atrial fibrillation: are they useful?

The AHA/ACC/ESC Guidelines for management of atrial fibrillation (AF) patients suggest criteria for adequate rate control. We hypothesized that AF patients fulfilling these criteria would have better quality of life (QoL) and exercise capacity compared to the ones not fulfilling the criteria.

Heart rate at rest, during moderate exercise and over 24 hours, and peak oxygen uptake (VO(2) peak) were measured in patients with permanent AF, all aged 75 years, recruited from two Norwegian municipalities. SF-36 Physical component summary (PCS) and Mental component summary (MCS) QoL scores were assessed. The similar program was also applied to 71 age-matched subjects in sinus rhythm.

Twenty-seven AF patients participated. Six (22%) of the AF patients satisfied the Guidelines' criteria for rate control; their VO(2) peak (mean +/- SD) was 23.0 +/- 6.5 versus 22.6 +/- 5.3 ml/kg/min in AF patients not satisfying the criteria, PCS score had median (25(th), 75(th) percentile) 44 (30, 57) versus 41 (31, 47), and MCS score had median 52 (40, 62) versus 56 (43, 60), all p-values > 0.500. When the rate criteria were applied to the group in sinus rhythm, only 45% had heart rates within the ranges recommended by the Guidelines for AF patients.

AF patients satisfying the Guidelines' criteria for adequate rate control did not have higher oxygen uptake or report better QoL than AF patients not satisfying the criteria.