Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/45978
Title: The impact of atrial fibrillation on oxygen uptake and haemodynamics in patients with heart failure: a systematic review and meta-analysis
Authors: Schmid, Veronika
Foulkes, Stephen J.
Dziano, Jenelle K.
Wang, Jing
VERWERFT, Jan 
Elliott, Adrian D.
Haykowsky, Mark J.
Editors: Börjesson, Mats
Issue Date: 2025
Publisher: OXFORD UNIV PRESS
Source: European Heart Journal Open, 5 (1) (Art N° oeaf003)
Abstract: Aims Atrial fibrillation (AF) may exacerbate exercise intolerance and haemodynamic limitations in individuals with heart failure (HF). Therefore, we performed a systematic search and meta-analysis to quantify the impact of AF on exercise tolerance (peak oxygen uptake, VO2peak; primary outcome) and exercise haemodynamics (secondary outcomes) in patients with HF.Methods and results PubMed, Scopus, and Web of Science databases were systematically searched for articles from inception to June 2024. Studies were included if they: (i) examined participants with HF; (ii) compared participants with AF to those not in AF (i.e. sinus rhythm); (iii) measured VO2peak from expired gas analysis. A fixed effects meta-analysis was performed, with groups compared using the weighted average effect size, represented as the weighted mean difference (WMD) with 95% confidence intervals (95% CI). Of 573 identified studies, 16 met the full inclusion comparing VO2peak in HF-patients in AF [HF-AF; n = 1,271, 68% male, 67 years, left ventricular ejection fraction (LVEF): 41%], and HF in sinus rhythm (HF-SR; n = 4910; 62% male, 62 years, LVEF: 41%). VO2peak was significantly lower in HF-AF (WMD: -1.55mL/kg/min, 95%-CI: -1.81 to -1.28, n = 6471). This coincided with a slightly lower peak heart rate (WMD: -2.94 b/min, 95%-CI: -4.76 to -1.13 b/min, n = 5115), decreased O2pulse (WMD: -1.58 mL/beat, 95% CI: -1.90 to -1.26, n = 3049), and lower systolic blood pressure (WMD: -11.11 mmHg, 95% CI: -14.01 to -8.21, n = 2409).Conclusion In patients with HF, AF is associated with greater VO2peak impairment, potentially due to reduced stroke volume and/or arterio-venous oxygen difference. This highlights the importance of combined strategies to identify and manage AF in individuals with HF.
Notes: Schmid, V (corresponding author), Tech Univ Munich, TUM Univ Hosp, Sch Med & Hlth, Dept Prevent Sports Med & Sports Cardiol, Georg Brauchle Ring 56, D-80992 Munich, Germany.; Schmid, V (corresponding author), Univ Alberta, Edmonton Clin Hlth Acad 2 045, Coll Hlth Sci, Fac Nursing,Integrated Cardiovasc Exercise Physiol, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada.
veronika.schmid@mri.tum.de
Keywords: Atrial fibrillation;Heart failure;Exercise intolerance;Exercise haemodynamics;Peak oxygen uptake
Document URI: http://hdl.handle.net/1942/45978
e-ISSN: 2752-4191
DOI: 10.1093/ehjopen/oeaf003
ISI #: 001472200700001
Rights: The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Category: A1
Type: Journal Contribution
Appears in Collections:Research publications

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