The effect of cardioversion on maximal exercise capacity in patients with chronic atrial fibrillation

To evaluate the effect of cardioversion on exercise capacity, 11 male patients (59 ± 8 years) with chronic atrial fibrillation underwent maximal exercise testing using gas exchange techniques before and after successful cardioversion to normal sinus rhythm. Testing was conducted 1 day prior to and a mean of 39 (range 10 to 95) days following cardioversion. Heart rate, blood pressure, and respiratory gas exchange responses were evaluated at rest, at a standard submaximal workload (3.0 mph/0% grade), at the gas exchange anaerobic threshold, and at maximal exertion. Cardioversion resulted in a mean decrease in resting heart rate of 37 beats/min (113 ± 16 versus 76 ± 10 beats/min, p < 0.001). While mean heart rate was approximately 50 beats/min lower following cardioversion at both submaximal stages of exercise p < 0.001), oxygen uptake was not different. At maximal exercise, heart rate was markedly reduced (192 ± 24 to 144 ± 21 beats/min, p < 0.001) and maximal oxygen uptake was higher (1.86 ± 0.5 to 2.06 ± 0.5 L/min, p < 0.05) after cardioversion. In addition, an improved efficiency of ventilation was observed at exercise levels exceeding 60% of maximal oxygen uptake.