Vіsnik Naukovih Doslіdžen' (Nov 2017)
INFLUENCE OF THE HEART RATE ON THE QUALITY OF LIFE AND SEVERITY OF ARRHYTHMIA SYMPTOMS IN PATIENTS WITH A PERMANENT ATRIAL FIBRILLATION NON-VALVULAR ETIOLOGY
Abstract
Atrial fibrillation (AF) is the most common chronic cardiac rhythm disorder and is rightly considered a 21st century epidemic. AF is usually associated with life quality worsening. That is why its improvement is one of the main tasks in the treatment of this group of patients. The aim of the study – to estimate the dynamic changes in the quality of life and the severity of arrhythmia symptoms (SAS ) in patients with a permanent atrial fibrillation non-valvular etiology during treatment with β-blockers (BB ), determination the critical value of the heart rate as a negative dynamic predictor of the life quality and SAS during 6 month monitoring, identification the preference for one of the HR control strategies. Material and Methods. 30 patients are consistently included in this study. The duration of observation was 238.3±17.0 days, the design consisted in 3 visits. Titration of the BB dose lasted 67.7±10.3 days (the interval between the first and second visits). Reception of the maximum or maximum tolerable dose of BB lasted 170.6±17.7 days (the interval between the second and final visits). ECG recording, Holter ECG, assessment of QoL and SAS were conducted during each of the visits. Results and Discussion. During follow-up period the resting heart rate in beats/min and ms by ECG on the first and second visits decreased significantly. At the same time, according to Holter ECG data, such a pattern was not found. When assessing life quality and SAS values, the number of points for the Minnesota living with heart failure questionnaire (MLH FQ) was significantly reduced at the 3rd visit, and the score for the physical health factor in the same questionnaire also decreased already at the 2nd visit. The conducted correlation analysis revealed a relationship between the score on the EHRA and SA F SAS scales with the mean daily HR value according to 24 h Holter ECG. When comparing both strategies strict control showed a significant advantage for the duration of the minimum, maximum and average RR intervals in beats/min and increasing their duration in ms, and consequently, the decrease in heart rate, according to ECG data (1, 2, 3 visits); decrease (1, 2, 3 visits), the mean maximum (1, 2, 3 visits), the mean minimum (1, 2, 3 visits), the mean in the active period (1, 2, 3 visits), the mean passive period (1 visit) heart rate in beats/min, circadian index (CI) (1, 2 visits), increase mean daily (1, 2, 3 visits), the mean maximum (1, 2, 3 visits), the mean minimum (1, 2, 3 visits), the mean in the active period (2, 3 visits), the mean in the passive period (1 visit), heart rate in ms according to the Holter ECG data. Conclusions. In patients with PA F non-valvular etiology during 6-month follow-up period Holter ECG was an objective indicator of heart rate control. Usage of BB for PA F has a positive effect on QoL by reducing the intensity of HF symptoms for the MLH FQ by improving the physical component of health. Fixed during Holter ECG mean daily HR > 91 beats/min is a predictor of SAS negative dynamics of the EHRA and SA F scales. Strict heart rate control shows a more pronounced effect on heart rate according to ECG and Holter ECG. None of the heart rate control strategies has demonstrated its benefits in terms of improving life quality and SAS .
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