Is the Median Hourly Ambulatory Heart Rate Range Helpful in Stratifying Mortality Risk among Newly Diagnosed Atrial Fibrillation Patients?

Background: The application of heart rate variability is problematic in patients with atrial fibrillation (AF). This study aims to explore the associations between all-cause mortality and the median hourly ambulatory heart rate range (AHRR˜24hr) compared with other parameters obtained from the Holter monitor in patients with newly diagnosed AF. Material and Methods: A total of 30 parameters obtained from 521 persistent AF patients’ Holter monitor were analyzed retrospectively from 1 January 2010 to 31 July 2014. Every patient was followed up to the occurrence of death or the end of 30 June 2017. Results:AHRR˜24hr was the most feasible Holter parameter. Lower AHRR˜24hr was associated with increased risk of all-cause mortality (adjusted hazard ratio [aHR] for every 10-bpm reduction: 2.70, 95% confidence interval [CI]: 1.75–4.17, p < 0.001). The C-statistic of AHRR˜24hr alone was 0.707 (95% CI: 0.658–0.756), and 0.697 (95% CI: 0.650–0.744) for the CHA2DS2-VASc score alone. By combining AHRR˜24hr with the CHA2DS2-VASc score, the C-statistic could improve to 0.764 (95% CI: 0.722–0.806). While using 20 bpm as the cut-off value, the aHR was 3.66 (95% CI: 2.05–6.52) for patients with AHRR˜24hr < 20 bpm in contrast to patients with AHRR˜24hr ≥ 20 bpm. Conclusions:AHRR˜24hr could be helpful for risk stratification for AF in addition to the CHA2DS2-VASc score.

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Effect of amiodarone on heart rate variability in patients with newly diagnosed atrial fibrillation (clinical observation)

Medical alphabet ◽

10.33667/2078-5631-2020-21-81-85 ◽

2020 ◽

pp. 81-85

Author(s):

E. P. Popova ◽

O. T. Bogova ◽

S. N. Puzin ◽

D. A. Sychyov ◽

V. P. Fisenko

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Heart Rate Variability ◽

Drug Therapy ◽

Heart Function ◽

Newly Diagnosed ◽

Class Iii ◽

Spectral Parameters ◽

Patient Will ◽

The Individual

Spectral analysis of heart rate variability gives an idea of the role of the autonomic nervous system in the regulation of chronotropic heart function. This method can be used to evaluate the effectiveness of drug therapy. Drug therapy should be carried out taking into account the individual clinical form of atrial fibrillation. Information about the vegetative status of the patient will undoubtedly increase the effectiveness of treatment. In this study, spectral parameters were studied in patients with newly diagnosed atrial fibrillation. The effect of antiarrhythmic drug class III amiodarone on the spectral parameters of heart rate variability was studied.

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Effect of Amiodarone, Sotalol and Bisoprolol on Heart Rate Variability in Patients with Atrial Fibrillation

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2020-10-07 ◽

2020 ◽

Vol 16 (5) ◽

pp. 721-729

Author(s):

E. P. Popova ◽

S. S. Puzin ◽

O. T. Bogova ◽

S. N. Puzin ◽

D. A. Sychev ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Heart Rate Variability ◽

Vagus Nerve ◽

Antiarrhythmic Drugs ◽

Newly Diagnosed ◽

Spectral Parameters ◽

Low Frequencies ◽

Sympathetic Influence

Aim. To study the effect of class III antiarrhythmic drugs (amiodarone and sotalol), and the β-blocker bisoprolol on the spectral parameters of heart rate variability in patients with different forms of atrial fibrillation (AF).Material and methods. Spectral analysis of heart rate variability of 5-minute electrocardiography intervals was used. The study included patients with newly diagnosed AF and having a duration of the disease from 6 months to 8 years. Arterial hypertension, coronary artery disease, myocardial infarction (in history), conduction disorders and type 2 diabetes mellitus were diagnosed as comorbidities. The following parameters were calculated: the total power (TP) of the spectrum, the power of very low frequencies (VLF), low frequencies (LF) and high frequencies (HF).Results. In the group of patients with newly diagnosed AF without concomitant diseases after administration of amiodarone, VLF prevails in the spectrum structure, which indicates a significant role of humoral factors in the regulation of heart rate. The power of LF, reflecting the activity of the sympathetic nervous system, prevails over HF power after administration of amiodarone. In patients with newly diagnosed AF, having concomitant diseases, sympathetic influences prevail over parasympathetic ones by 3.6 times after administration of amiodarone. In the group of patients who have reduced the number of comorbidities, the LF/HF decreases and is only 1.66 after administration of amiodarone. The decrease in the number of negative factors is also accompanied by an increase in the influence of the vagus nerve on the activity of the heart. In the study of the effects of sotalol, the LF/HF in this group was twice lower in the group of patients with long-term AF. In patients receiving bisoprolol as antiarrhythmic therapy, the proportion of LF in the group of patients with newly diagnosed AF is 2 times lower, and the proportion of HF is twice higher than in the group of patients with long-term AF.Conclusion. The effect of antiarrhythmic drugs on the spectral parameters of heart rate variability depends on the duration AF. The presence of concomitant diseases of the cardiovascular system can significantly change the effect of antiarrhythmic drugs on the spectral parameters of heart rate variability and is accompanied by an increase in sympathetic activity. In patients with newly diagnosed AF, amiodarone and sotalol cause a similar effect – the predominance of sympathetic influence; when using bisoprolol, the predominant influence belongs to the vagus nerve. In patients with long-term AF, the opposite effect of drugs is observed: the use of amiodarone is accompanied by a more pronounced influence of the vagus nerve, and bisoprolol – the predominance of sympathetic influence. When using sotalol, sympathetic influences also prevail, more pronounced in patients with newly diagnosed AF.

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Severe Cardiac Autonomic Derangement and Altered Ventricular Repolarization Pave the Way to Postoperative Atrial Fibrillation

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000203 ◽

2015 ◽

Vol 10 (6) ◽

pp. 398-405 ◽

Cited By ~ 4

Author(s):

Jurij Matija Kališnik ◽

Eva Hrovat ◽

Alenka Hrastovec ◽

Viktor Avbelj ◽

Janez Žibert ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Heart Rate Variability ◽

Detrended Fluctuation Analysis ◽

Postoperative Atrial Fibrillation ◽

Fluctuation Analysis ◽

Heart Rate Variability Parameter ◽

Qtc Interval ◽

Increased Risk ◽

Detrended Fluctuation

Objective Postoperative atrial fibrillation (POAF) is a frequent complication after heart surgery. It has been shown that cardiac autonomic derangement plays a significant role in the genesis of atrial fibrillation (AF) and that AF might also be promoted by altered repolarization. Thus, the aim of our study was to determine the levels of cardiac autonomic modulation and repolarization properties in patients developing POAF. Methods Seventy-nine patients scheduled for aortic and/or coronary artery bypass grafting surgery with cardiopulmonary bypass were enrolled prospectively. High-resolution 20-minute electrocardiogram recordings were obtained day before surgery to determine P, PR, QT, and QTc intervals, as well as linear (time and frequency domain) and nonlinear heart rate variability parameters (fractal dimension and detrended fluctuation analysis). QTc interval was calculated using Framingham correction. Results Twenty-nine patients developed POAF (AF group), and 50 did not (non-AF group). Groups were similar regarding demographics, surgery type, and perioperative characteristics, except for older age in the AF group. QT and QTc intervals (Framingham) were longer in the AF group [442 (44) vs 422 (28) milliseconds, P = 0.018; and 448 (44) vs 431 (24) milliseconds, P = 0.031 and P = 0.019, respectively]. Time domain heart rate variability parameter PNN50 (percentage of pairs of adjacent NN intervals differing >50 milliseconds) was higher [14% (21%) vs 8% (16%), P = 0.015], and nonlinear parameter detrended fluctuation analysis α2 was lower in the AF group [0.81 (0.21) vs 0.91 (0.20), P = 0.031]. Conclusions Profound cardiac autonomic derangement, suggestive of parasympathetic excessive modulation, exists preoperatively in patients inclined to POAF after cardiac surgery, whereby parameters PNN50 and α2 differentiated the AF from the non-AF group. Prolonged QTc intervals are associated with an increased risk of POAF.

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Heart Rate and Heart Rate Variability Changes Are Not Related to Future Cardiovascular Disease and Death in People With and Without Dysglycemia: A Downfall of Risk Markers? The Whitehall II Cohort Study

10.2337/figshare.13526351.v1 ◽

2021 ◽

Author(s):

Christian S Hansen ◽

Marit E Jørgensen ◽

Marek Malik ◽

Daniel R Witte ◽

Eric J Brunner ◽

...

Keyword(s):

Cardiovascular Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Cohort Study ◽

Population Based ◽

Increased Risk ◽

All Cause Mortality ◽

Future Events ◽

Design And Methods

Objective Higher resting heart rate (rHR) and lower heart rate variability (HRV) are associated with increased risk of cardiovascular disease (CVD) and all-cause mortality in people with and without diabetes It is unknown whether temporal changes in rHR and HRV may contribute to this risk. We investigated associations between 5-year changes in rHR and HRV and risk of future CVD and death, taking into account participants’ baseline glycemic state. Research design and Methods In this prospective population-based cohort study we investigated 4,611 CVD-free civil servants (mean age 60, SD=5.9 years, 70% men). rHR and/or 6 indices of HRV were measured. Associations of 5-year change in 5-minute rHR and HRV with fatal- and non-fatal CVD and all-cause mortality or the composite of the two were assessed with adjustments for relevant confounders. Effect modification by glycemic state was tested. Results At baseline, 63% of participants were normoglycemic, 29% had prediabetes and 8% had diabetes. During a median (IQR) follow-up of 11.9 (11.4;12.3) years, 298 participants (6.5%) experienced a CVD event and 279 (6.1%) died from non-CVD related causes. We found no association between 5-year changes in rHR and HRV and future events. Only baseline rHR was associated with all-cause mortality. A 10 beats per minute higher baseline level showed a 11.4% higher rate of all-cause mortality (95%CI:1.0;22.9%, P=0.032). Glycemic state did not modify associations. Conclusion Changes in rHR and HRV and possibly also baseline values of these measures are not associated with future CVD or mortality in people with or without dysglycemia.

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U-Shaped Association of the Heart Rate Variability Triangular Index and Mortality in Hemodialysis Patients With Atrial Fibrillation

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.751052 ◽

2021 ◽

Vol 8 ◽

Author(s):

Matthias C. Braunisch ◽

Christopher C. Mayer ◽

Stanislas Werfel ◽

Axel Bauer ◽

Bernhard Haller ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Heart Rate Variability ◽

Cardiovascular Mortality ◽

Cox Regression ◽

Hemodialysis Patients ◽

Dialysis Vintage ◽

All Cause Mortality ◽

Non Linear ◽

Fourth Quartile

Background: Atrial fibrillation (AF) is common in hemodialysis patients and contributes to increased mortality. We aimed to examine heart rate variability triangular index (HRVI) in hemodialysis patients with AF as it has recently been reported to predict mortality in AF patients without kidney disease.Methods: A total of 88 patients on hemodialysis with a medical history of AF or newly diagnosed AF underwent 24-h electrocardiography recordings. The primary endpoint of cardiovascular mortality was recorded during a median follow up of 3.0 years. Risk prediction was assessed by Cox regression, both unadjusted and adjusted for the Charlson Comorbidity Index and the Cardiovascular Mortality Risk Score.Results: Median age was 76 years, median dialysis vintage was 27 months. Altogether, 22 and 44 patients died due to cardiovascular and non-cardiovascular causes. In 55% of patients AF was present during the recording. Kaplan-Meier plots of HRVI quartiles suggested a non-linear association between HRVI, cardiovascular, and all-cause mortality which was confirmed in non-linear Cox regression analysis. Adjusted linear Cox regression revealed a hazard ratio of 6.2 (95% CI: 2.1–17.7, p = 0.001) and 2.2 (95% CI: 1.3–3.8, p = 0.002) for the outer quartiles (combined first and fourth quartile) for cardiovascular and all-cause mortality, respectively. Patients in the first quartile were more likely to have sinus rhythm whereas patients in the fourth quartile were more likely to have AF.Conclusions: We found a U-shaped association between HRVI and mortality in hemodialysis AF patients. The results might contribute to risk stratification independent of known risk scores in hemodialysis AF patients.

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Measuring Heart Rate Variability in Patients Admitted with ST-Elevation Myocardial Infarction for the Prediction of Subsequent Cardiovascular Events: A Systematic Review

Medicina ◽

10.3390/medicina57101021 ◽

2021 ◽

Vol 57 (10) ◽

pp. 1021

Author(s):

Crischentian Brinza ◽

Mariana Floria ◽

Adrian Covic ◽

Alexandru Burlacu

Keyword(s):

Myocardial Infarction ◽

Heart Rate ◽

Heart Rate Variability ◽

Cardiovascular Events ◽

St Elevation Myocardial Infarction ◽

Major Adverse Cardiovascular Events ◽

Prognostic Information ◽

Increased Risk ◽

All Cause Mortality ◽

St Elevation

Ischemic heart disease represents the leading cause of death, emphasizing risk stratification and early therapeutic intervention. Heart rate variability (HRV), an indirect marker of autonomic nervous system activity, was investigated extensively as a risk factor for adverse cardiovascular events following acute myocardial infarction. Thus, we systematically reviewed the literature to investigate the association of HRV parameters with mortality and adverse cardiovascular events in patients presenting with ST-elevation myocardial infarction (STEMI). Following the search process in the MEDLINE (PubMed), Embase, and Cochrane databases, nine studies were included in the final analysis. Lower time-domain HRV parameters and a higher ratio between power in the low-frequency (LF) band and power in the high-frequency (HF) band (LF/HF) were associated with higher all-cause mortality during follow-up, even in patients treated mainly with percutaneous coronary interventions (PCI). Although most studies measured HRV on 24 h ECG recordings, short- and ultra-short-term measures (1 min and 10 s, respectively) were also associated with an increased risk of all-cause mortality. Although data were discrepant, some studies found an association between HRV and cardiac mortality, reinfarction, and other major adverse cardiovascular events. In conclusion, HRV measurement in patients with STEMI could bring crucial prognostic information, as it was associated with an increased risk of all-cause mortality documented in clinical studies. More and larger clinical trials are required to validate these findings in contemporary patients with STEMI in the context of the new generation of drug-eluting stents and current antithrombotic and risk-modifying therapies.

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Cardiac Autonomic Dysfunction and Incidence of de novo Atrial Fibrillation: Heart Rate Variability vs. Heart Rate Complexity

Frontiers in Physiology ◽

10.3389/fphys.2020.596844 ◽

2020 ◽

Vol 11 ◽

Author(s):

Niels Wessel ◽

Karsten Berg ◽

Jan F. Kraemer ◽

Andrej Gapelyuk ◽

Katrin Rietsch ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Heart Rate Variability ◽

Autonomic Dysfunction ◽

De Novo ◽

Individual Risk ◽

Atrial Tachyarrhythmias ◽

Cardiac Autonomic Dysfunction ◽

Increased Risk ◽

Heart Rate Complexity

BackgroundThe REACT DX registry evaluates standard therapies to episodes of long-lasting atrial tachyarrhythmias and assesses the quality of sensing and stability of the lead and the implantable cardioverter-defibrillator (ICD) (BIOTRONIK Lumax VR-T DX and successors) over at least a 1-year follow-up period.ObjectiveTo study the association between the risk of de novo device-detected atrial fibrillation (AF), the autonomic perturbations before the onset of paroxysmal AF and a 7-days heart rate variability (7dHRV) 1 month after ICD implantation.MethodsThe registry consists of 234 patients implanted with an ICD, including 10 with de novo long-lasting atrial tachyarrhythmias with no prior history of AF. The patients were matched via the propensity-score methodology as well as for properties directly influencing the ECGs recorded using GE CardioMem CM 3000. Heart rate variability (HRV) analysis was performed using standard parameters from time- and frequency-domains, and from non-linear dynamics.ResultsNo linear HRV was associated with an increased risk of AF (p = n.s.). The only significant approach was derived from symbolic dynamics with the parameter “forbidden words” which distinguished both groups on all 7 days of measurements (p < 0.05), thereby quantifying the heart rate complexity (HRC) as drastically lower in the de novo AF group.ConclusionCardiac autonomic dysfunction denoted by low HRC may be associated with higher AF incidence. For patients with mild to moderate heart failure, standard HRV parameters are not appropriate to quantify cardiac autonomic perturbations before the onset of AF. Further studies are needed to determine the individual risk for AF that would enable interventions to restore autonomic balance in the general population.

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Heart Rate and Heart Rate Variability Changes Are Not Related to Future Cardiovascular Disease and Death in People With and Without Dysglycemia: A Downfall of Risk Markers? The Whitehall II Cohort Study

10.2337/figshare.13526351 ◽

2021 ◽

Author(s):

Christian S Hansen ◽

Marit E Jørgensen ◽

Marek Malik ◽

Daniel R Witte ◽

Eric J Brunner ◽

...

Keyword(s):

Cardiovascular Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Cohort Study ◽

Population Based ◽

Increased Risk ◽

All Cause Mortality ◽

Future Events ◽

Design And Methods

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Impact of Baseline Neutrophil-to-Lymphocyte Ratio on Long-Term Prognosis in Patients With Atrial Fibrillation

Angiology ◽

10.1177/00033197211000495 ◽

2021 ◽

pp. 000331972110004

Author(s):

Shuang Wu ◽

Yan-min Yang ◽

Jun Zhu ◽

Jia-meng Ren ◽

Juan Wang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Continuous Variable ◽

Cox Proportional Hazards ◽

Neutrophil To Lymphocyte Ratio ◽

Long Term Outcomes ◽

Lymphocyte Ratio ◽

Net Reclassification Improvement ◽

Increased Risk ◽

All Cause Mortality

We performed a retrospective analysis involving 1269 patients with atrial fibrillation (AF) to evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) on long-term outcomes. The primary outcomes were all-cause mortality and combined end point events (CEEs). Cox proportional hazards regression analysis and net reclassification improvement (NRI) analysis were performed. During a median follow-up of 3.32 years, 285 deaths and 376 CEEs occurred. With the elevation of the NLR, the incidence of all-cause mortality (2.77, 4.14, 6.12, and 12.18/100 person-years) and CEEs (4.19, 7.40, 8.03, and 15.22/100 person-years) significantly increased. Multivariate Cox analysis indicated that the highest NLR quartile was independently associated with the incidence of all-cause mortality (hazard ratio [HR] = 1.77, 95% CI: 1.19-2.65) and CEEs (HR = 1.66, 95% CI: 1.18-2.33). When the NLR was analyzed as a continuous variable, a 1-unit increment in log NLR was related to 134% increased risk of all-cause mortality and 119% increased risk of CEEs. Net reclassification improvement analysis revealed that NLR significantly improved risk stratification for all-cause death and CEEs by 15.0% and 9.6%, respectively. Neutrophil-to-lymphocyte ratio could be an independent predictor of long-term outcomes in patients with AF.

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Discharge heart rate and clinical outcomes in hospitalized heart failure patients with coexisted atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1157 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Xing ◽

X Bai ◽

J Li

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Rate ◽

Clinical Outcome ◽

Confidence Interval ◽

Clinical Outcomes ◽

Beta Blockers ◽

Funding Source ◽

Proportional Hazard ◽

Cox Proportional Hazard

Abstract Background Whether discharge heart rate for hospitalized heart failure (HF) patients with coexisted atrial fibrillation (AF) is associated with long-term clinical outcomes and whether this association differs between patients with and without beta-blockers have not been well studied. Purpose We investigated the associations between discharge heart rate and clinical outcomes in hospitalized HF patients with coexisted AF, while stratified to beta-blockers at discharge. Methods The study cohort included 1631 HF patients hospitalized primarily with AF, which was from the China PEACE Prospective Heart Failure Study. Clinical outcome was 1-year combined all-cause mortality and HF hospitalization after discharge. We analyzed association between outcome and heart rate at discharge with restricted cubic spline and Cox proportional hazard ratios (HR). Results The median age was 68 (IQR: 60- 77) years, 41.9% were women, discharge heart rate was (median (IQR)) 75 (69- 84) beats per minute (bpm), and 60.2% received beta-blockers at discharge. According to the result of restricted cubic spline plot, the relationship between discharge heart rate and clinical outcome may be nonlinear (P<0.01). Based on above result, these patients were divided into 3 groups: lowest <65 bpm, middle 65–86 bpm and highest ≥87 bpm, clinical outcomes occurred in 128 (64.32%), 624 (53.42%) and 156 (59.32%) patients in the lowest, middle, and highest groups respectively. In the Cox proportional hazard analysis, the lowest and highest groups were associated with increased risks of clinical outcome compared with the middle group (HR: 1.289, 95% confidence interval (CI): 1.056 - 1.573, p=0.013; HR: 1.276, 95% CI: 1.06 - 1.537, p=0.01, respectively). And a significant interaction between discharge heart rate and beta-blocker use was observed (P<0.001 for interaction). Stratified analysis showed the lowest group was associated with increased risks of clinical outcomes in patients with beta-blockers (HR: 1.584, 95% confidence interval (CI): 1.215–2.066, p=0.001). Conclusion There may be a U-curve relationship between discharge heart rate and clinical outcomes in hospitalized HF patients with coexisted AF. They may have the best clinical outcomes with heart rates of 65 - 86 bpm. And strict heart rate control (<65 bpm) may be avoided for patients who discharge with beta-blockers. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): This work was supported by the National Key Research and Development Program (2017YFC1310803) from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science (2017-I2M-B&R-02); the 111 Project from the Ministry of Education of China (B16005).

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