Hemodynamic characteristics and exercise tolerance in patients with atrial fibrillation during mechanotherapy after ischemic stroke

Aim. To study hemodynamic characteristics and exercise tolerance during mechanotherapy in patients after ischemic stroke (IS).

Material and methods. The study included 80 patients after IS. Mean age was 61,0±10,5 years, while the duration of ischemic stroke — 13,1±8,5 months. Rehabilitation routing score was 4. Fifty patients have sinus rhythm, while 10 — paroxysmal atrial fibrillation (AF), and 20 — permanent AF. According to Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, there were 21 patients with atherothrombotic stroke, 30 patients with cardioembolic stroke, 29 patients with stroke of unknown etiology. The following examinations were performed: echocardiography with assessment of left ventricular (LV) global longitudinal strain (GLS), blood test with assessment of N-terminal probrain natriuretic peptide (NT-proBNP). Mechanotherapy was performed daily on a Reck MOTOmed muvi simulator (Germany), with hemodynamic assessment during training on days 1 and 12.

Results. Patients with AF, compared with patients in sinus rhythm, were significantly older (65,7±7,2 vs, 58,0±11,2 years; p=0,002) and had higher NTproBNP levels (192,1 [30,3; 282,2] vs, 15,7 [0; 16,2] pg/ml; p<0,001). In patients with sinus rhythm, compared with patients with permanent AF, the LV ejection fraction was higher — 59,4±4,8 vs 52,7±6,6% (p<0,001), the left atrial volume index was lower — 20,2±7,9 vs 45,0±15,6 ml/min (p<0,001), the LV GLS in absolute values was higher — -16,4±2,0 vs -11,7±2,5% (p<0,001). On the 1^st day of mechanotherapy, patients with sinus rhythm demonstrate a greater exercise distance and a higher value of maximum oxygen consumption compared with patients with permanent AF. By the 12^th day of rehabilitation, a significant increase in exercise distance was observed in both groups as follows: in sinus rhythm, 1,9±0,9 km vs 2,4±0,9 km (p<0,001), and in persistent AF, 1,3±0,5 km vs 1,8±0,9 km (p=0,005). No clinically significant hemodynamic disturbances were observed during mechanotherapy in any patient, regardless of AF.

Conclusion. During mechanotherapy, patients with AF demonstrated significantly lower exercise tolerance compared to patients with sinus rhythm. Persistent AF partially limited the effectiveness of mechanotherapy: by the 12^th day of training, patients achieved an increase in distance, but no increase in power was achieved. Hemodynamic parameters during exercise did not limit training in either patients with sinus rhythm or AF. Mechanotherapy as part of an individualized rehabilitation program after IS did not provoke arrhythmia attacks in patients with paroxysmal AF.

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