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

• Type of Material: Article
• Authors: Sunil K. Agarwal, Mount Sinai School of Medicine; Faye L. Norby, University of Minnesota; Eric A. Whitsel, University of North Carolina; Elsayed Z. Soliman, Wake Forest School of Medicine; Lin Y. Chen, University of Minnesota; Laura R. Loehr, University of North Carolina; Valentin Fuster, Mount Sinai School of Medicine; Gerardo Heiss, University of North Carolina; Josef Coresh, Johns Hopkins University; Alvaro Alonso, Emory University
• Language: English
• Date: 2017-01-24
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 American College of Cardiology Foundation
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jacc.2016.10.059
• Title of Journal or Parent Work: Journal of the American College of Cardiology
• ISSN: 0735-1097
• Volume: 69
• Issue: 3
• Start Page: 291
• End Page: 299
• Grant/Funding Information: SKA was supported by a National Institutes of Health/National Heart, Lung, and Blood Institute T32HL007024 (PI: Prof. Coresh) Cardiovascular Epidemiology Training Grant.; Additional funding for this study was provided by grants 16EIA26410001 from the American Heart Association and 1RC1HL099452-01 from NHLBI.; The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C).
• Keywords: DISEASE; Cardiovascular System & Cardiology; Life Sciences & Biomedicine; frequency; heart rate variability; METAANALYSIS; ABLATION; ONSET; sympathetic; parasympathetic; TONE; arrhythmia; ATHEROSCLEROSIS RISK; HEART-RATE-VARIABILITY; Cardiac & Cardiovascular Systems; SPECTRAL-ANALYSIS; Science & Technology; HYPERTENSIVE PATIENTS; NERVOUS-SYSTEM
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Background Cardiac autonomic perturbations frequently antecede onset of paroxysmal atrial fibrillation (AF). Interventions that influence autonomic inputs to myocardium 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.