- Uncontrolled rapid ventricular rates during AF may cause sevre symptoms and may lead to the development of tachycardia-induced cardiomyopathy, Left ventricular dysfunction and CHF.
- precise targets for optimal ventricular rates during AF remain controversial
- these criteria for rate control were not based on strong clinical evidence, and it was not clear whether achieving these rate control targets would translate to clinical benefit.
Heart
Rate Targets:
- 2006 consensus guidelines for AF management recommended target heart rates of 60 to 80 bpm at rest and 90 to 115 bpm during moderate exercise
- AFFIRM trial recommended targets for rate control were no higher than 80 bpm at rest and no higher than 110 bpm during a 6-minute walk test, and an average heart rate no higher than 100 bpm over 18+ hours of Holter monitoring with no rates >100% of maximal age-predicted heart rate
- RACE trial target resting heart rate <100 bpm
Recommendations:
- RACE study showed no differences in cardiovascular morbidity, mortality, and quality of life between patients with achieved resting heart rates <80 bpm versus ≥80 bpm
- However, there is a benefit to moderate rate control.
- Patients with resting heart rates >100 bpm were more likely to reach a composite end point of mortality, cardiovascular hospitalization, or myocardial infarction in comparison with patients with resting rates ≤100 bpm
- It is the current clinical practice to target resting heart rates in the range of 60 to 70 bpm for patients with AF and CHF
- Attention paid to avoiding excessively slow heart rates during rest/sleep and avoiding extremely high rates (above the maximal age-predicted heart rate) during exertion
- Atrial Fibrilation. http://circ.ahajournals.org/content/124/24/2746.full
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