Pulse deficit in atrial fibrillation - a different perspective on rhythm or rate control strategy.

Background: Pulse deficit (PD) is a frequently unused but crucial clinical finding in atrial fibrillation (AF) diagnosis.

Aims: We aimed to investigate the relationship between PD and exercise intolerance in AF patients to remodel the treatment in case of a favorable outcome.

Methods: This prospective study was conducted with 273 permanent AF patients between September 2019 and October 2020. An exercise stress test stratified by age and sex-matched was performed to determine exercise intolerance, and the patients were divided into 2 groups based on physical capacity: low (<75 percentile as Group 1) (n = 160; 58.6%) and adequate (≥75 percentile as Group2) (n = 113; 41.4%).

Results: The mean (standard deviation [SD]) PD of exercise intolerance patients was significantly higher than patients with adequate exercise capacity (17 [4] vs. 12 [2]; P <0.001). Moreover, PD was independently associated with exercise intolerance after adjusting for potential covariates (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.51-0.69; P <0.001). In both univariate and multivariable analyses, higher heart rates had a stronger relationship with exercise intolerance (mean [SD], 107 [11] vs. 99 [10]; P <0.001; OR, 0.92; 95% CI, 0.89-0.96; P <0.001). Also, there was a positive correlation between heart rate and PD (r = 0.431; P <0.001).

Conclusions: Increased PD was associated with decreased exercise capacity in persistent AF patients. Rhythm control strategy should be considered to increase left ventricular filling pressures in AF patients with high PD and exercise intolerance.