Table 3.

Important Exercise Testing Considerations and Procedures in Patients with Atrial Fibrillation

Acute Physiologic Adjustments • Due to loss of a normal atrial contraction and an associated reduction in cardiac output, exercise capacity in patients with AF is 15% to 20% below that of people in sinus rhythm. • Heart rate at rest, during submaximal exercise, and at peak exercise is often higher in patients with AF when compared to people in sinus rhythm. • Peak ventricular rate often exceeds age-predicted maximum.

Testing Considerations and Procedures • Adopt testing principles used for patients without AF. • Patients should undergo testing while taking effective rate-controlling and anticoagulation medications. • Exercise testing can help with titrating medications that target ventricular control during exertion. • Sign- and symptom-limited testing is appropriate. • An exercise test should not be performed in an AF patient with an uncontrolled, tachycardic ventricular rate. • There is relatively limited data addressing the safety of exercise testing in patients with AF; current data suggests that maximal effort under proper supervision is appropriate.

Abbreviation: AF, atrial fibrillation.