Cardiac Autonomic Dysfunction and Incidence of Atrial Fibrillation Results From 20 Years Follow-Up

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:69

Article

Agarwal, Sunil K.^1,2  Norby, Faye L.³  Whitsel, Eric A.⁴  Soliman, Elsayed Z.⁵  Chen, Lin Y.⁶  Loehr, Laura R.⁴  Fuster, Valentin¹  Heiss, Gerardo⁴  Coresh, Josef²  Alonso, Alvaro⁷ 

[1] Mt Sinai Sch Med, Cardiovasc Inst, Guggenheim Pavil,1190 Fifth Ave 1 West, New York, NY 10029 USA

[2] Johns Hopkins Univ, Div Gen Internal Med & Epidemiol, Baltimore, MD USA

[3] Univ Minnesota, Dept Epidemiol & Cardiol, Minneapolis, MN USA

[4] Univ N Carolina, Dept Epidemiol & Med, Chapel Hill, NC USA

[5] Wake Forest Sch Med, Dept Epidemiol & Prevent, Winston Salem, NC USA

[6] Univ Minnesota, Sch Med, Dept Med, Cardiovasc Div, Minneapolis, MN 55455 USA

[7] Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA 30322 USA

关键词: arrhythmia;    frequency;    heart rate variability;    parasympathetic;    sympathetic;   

DOI  :  10.1016/j.jacc.2016.10.059

来源: Elsevier

【 摘 要 】

BACKGROUND Cardiac autonomic perturbations frequently antecede onset of paroxysmal atrial fibrillation (AF). Interventions that influence autonomic inputs tomyocardium may prevent AF. However, whether low heart rate or heart rate variability (HRV), which are noninvasive measures of cardiac autonomic dysfunction, are associated with AF incidence is unclear. OBJECTIVES This study sought to study the association between HRV and risk of AF. METHODS This study included 11,715 middle-aged adults in the ARIC (Atherosclerosis Risk In Communities) cohort with heart rate and HRV measures obtained from 2-min electrocardiogram recordings performed at baseline (1987 to 1989). These measures included SD of normal-to-normal RR intervals, high-frequency (HF) (0.15 to 0.40 Hz), low-frequency (0.04 to 0.15 Hz), and the low-frequency/HF ratio (denoting a greater sympathetic to parasympathetic dominance). Incident AF cases were ascertained by electrocardiogram at ARIC follow-up visits, hospital discharge diagnosis, or death certificates through 2011. RESULTS During an average follow-up of 19.4 years, 1,580 or 13.5% of participants developed AF. A baseline heart rate <60 beats/min was associated modestly with an increased risk of AF. Lower overall HRV as well as increased sympathetic/parasympathetic tone were associated independently with a higher risk of AF; the hazard ratio for each 1 SD lower SD of normal-to-normal RR intervals was 1.14 (95% confidence interval: 1.08 to 1.21), for HF was 1.12 (95% confidence interval: 1.06 to 1.17), and for low frequency/HF was 1.08 (95% confidence interval: 1.03 to 1.14). CONCLUSIONS Cardiac autonomic dysfunction denoted by low resting short-term HRV was associated with higher AF incidence. A low heart rate may be associated with higher AF risk. Further studies are needed to determine whether interventions in the general population to restore autonomic balance may prevent AF. (C) 2017 by the American College of Cardiology Foundation.

【 授权许可】

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