A. B. Korneev
Aim . Permanent atrial fibrillation (AF) requires rate control. However, the optimal heart rate (HR) remains a matter of debate. Hemodynamic parameters such as mean arterial pressure (MAP) and the proportion of hemodynamically ineffective beats (HIB), derived from pulse pressure (PP), may provide insight into the hemodynamic characteristics of AF at different HRs and left ventricular ejection fractions (LVEF). Methods . The study included 135 patients with permanent AF (aged 37-90 years, symptom class 1-2A according to the mEHRA scale). For each patient, beat-to-beat systolic BP, diastolic BP, and PP were measured using the “volume clamp” method over a 15-minute period with the “Cardiotechnika-SAKR” system (Incart, Saint Petersburg). On each cardiac cycle, MAP and its variability were calculated using two independent metrics: Average Real Variability (ARV) and Root Mean Square of Successive Differences (RMSSD). Results . The percentage of HIBs, defined per patient as deviations from the mean PP, considered as 1 («mild» 110 bpm), except 90-110 bpm, HIBs were more frequent in patients with reduced LVEF (110 bpm, MAP was 80.4 ± 12.3 mmHg in the reduced LVEF group versus 94.1 ± 14.1 mmHg in the preserved LVEF group (p0.05). Conclusion . Heart rate control in permanent AF should be individualized, hemodynamically guided, and account for LVEF. Beat-to-beat monitoring enables identification of the optimal HR that minimizes HIBs and MAP variability while maintaining MAP within accepted reference values, particularly in patients with impaired contractile function.