The impact of atrial fibrillation on oxygen uptake and haemodynamics in patients with heart failure: a systematic review and meta-analysis

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.