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Heart rate variability and stroke or systemic embolism in patients with atrial fibrillation

2024; Elsevier BV; Volume: 21; Issue: 9 Linguagem: Inglês

10.1016/j.hrthm.2024.05.028

1556-3871

Peter Hämmerle, Stefanie Aeschbacher, Vincent Schlageter, Michael Coslovsky, Elisa Hennings, Philipp Krisai, Federica Coduri, Manuel R. Blum, Nicolas Rodondi, Tobias Reichlin, Andreas Müller, Annina Stauber, Giorgio Moschovitis, Elia Rigamonti, Jürg H. Beer, Peter Ammann, Leo H. Bonati, David Conen, Stefan Osswald, Michael Kühne, Christine S. Zuern, Stefanie Aeschbacher, Katalin Bhend, Steffen Blum, Leo H. Bonati, Desirée Carmine, David Conen, Ceylan Eken, Urs Fischer, Corinne Girroy, Elisa Hennings, Philipp Krisai, Michael Kühne, N. Mader, Christine Meyer‐Zürn, Pascal Meyre, Andreas U. Monsch, Luke Mosher, Christian Müller, Stefan Osswald, Rebecca E. Paladini, Raffaele Peter, Adrian Schweigler, Christian Sticherling, Thomas D. Szucs, Gian Völlmin, Stefan Osswald, Michael Kühne, Drahomir Aujesky, Juerg Fuhrer, Laurent Roten, Simon Jung, Heinrich P. Mattle, Seraina Netzer, Luise Adam, Carole E. Aubert, Martin Feller, Axel Loewe, Elisavet Moutzouri, Claudio Schneider, Tanja Flückiger, Cindy Groen, Lukas Ehrsam, Sven Hellrigl, Alexandra Nuoffer, Damiana Rakovic, Nathalie Schwab, Rylana Wenger, Tu Hanh Zarrabi Saffari, Nicolas Rodondi, Tobias Reichlin, Christopher Beynon, Roger Dillier, Michèle Deubelbeiss, Franz R. Eberli, C Franzini, Isabel Juchli, Claudia Liedtke, Samira Murugiah, Jacqueline Nadler, Thayze Obst, Jasmin Roth, Fiona Schlomowitsch, Xiaoye Schneider, Katrin Studerus, Noreen Tynan, Dominik Weishaupt, Andreas Müller, Corinne Friedli, Silke Küest, Karin Scheuch, Denise Hischier, Nicole R. Bonetti, Alexandra Grau, Jonas Villinger, Eva Laube, Philipp Baumgartner, Mark G. Filipovic, Marcel Frick, Giulia Montrasio, S. Leuenberger, Franziska Rutz, Jürg H. Beer, Angelo Auricchio, Adriana Anesini, Cristina Camporini, Maria Luce Caputo, Rebecca Peronaci, François Regoli, Martina Ronchi, Giulio Conte, Roman Brenner, David Altmann, Karin Fink, Michaela Gemperle, Peter Ammann, Mathieu Firmann, Sandrine Foucras, Martine Rime, Daniel Hayoz, Benjamin Berte, Kathrin Bühler, Virgina Justi, Frauke Kellner‐Weldon, Melanie Koch, Brigitta Mehmann, Sonja Meier, Myriam Roth, Andrea Ruckli-Kaeppeli, Ian Russi, Kai Schmidt, Mabelle Young, Richard Kobza, Elia Rigamonti, Carlo W. Cereda, Alessandro Cianfoni, Maria Luisa De Perna, Jane Frangi-Kultalahti, Patrizia Assunta Mayer Melchiorre, Anica Pin, Tatiana Terrot, Luisa Vicari, Giorgio Moschovitis, Georg Ehret, Hervé Gallet, Elise Guillermet, François Lazeyras, Karl‐Olof Lövblad, Patrick Perret, Philippe Tavel, Cheryl Terés, Dipen Shah, Nathalie Lauriers, Marie Méan, Sandrine Salzmann, Jürg Schläpfer, Alessandra Pia Porretta, Andrea Grêt, Ján Novák, Sandra Vitelli, Frank‐Peter Stephan, Jane Frangi-Kultalahti, Augusto Gallino, Luisa Vicari, Marcello Di Valentino, Helena Aebersold, Fabienne Foster, Matthias Schwenkglenks, Marco Düring, Tim Sinnecker, Anna Altermatt, Michael Amann, P Huber, Manuel Hürbin, Esther Ruberte, Alain Thöni, Jens Würfel, Vanessa Zuber, Michael Coslovsky, Pia Neuschwander, Patrick Simon, Olivia Wunderlin, Ramun Schmid, Christian R. Baumann,

Cardiovascular Syncope and Autonomic Disorders

Background: Stroke remains one of the most serious complications in atrial fibrillation (AF) patients and has been linked to disturbances of the autonomic nervous system. Objective:We hypothesized that impaired cardiac autonomic function might be associated with an enhanced stroke risk in AF patients. Methods:We enrolled 1922 AF patients who were either in sinus rhythm (SR-group, n=1121) or AF (AF-group, n=801) on a 5-minute resting ECG recording.HRV triangular index (HRVI), standard deviation of normal-to-normal intervals, root mean square root of successive differences of normal-to-normal intervals, mean heart rate, 5-min total power and power in the high frequency, low frequency and very low frequency range were calculated.We constructed Cox regression models to examine the association of HRV parameters with the composite endpoint of stroke or systemic embolism.Results: Mean age was 71±8 years in the SR group and 75±8 in the AF group.37 patients in the SR group (3.4%) and 60 patients in the AF group (8.0%) experienced a stroke or systemic embolism during a follow-up time of 5 years.In patients with SR, HRVI <15 was the strongest HRV parameter to be associated with stroke or systemic embolism (hazard ratio 3.04; 95% confidence interval 1.3-7.0;p=0.009) after adjustment for multiple confounders.In the AF group, we found no HRV parameter to be associated with the composite endpoint. Conclusion:HRVI measured during SR on a single 5-minute ECG recording is independently associated with stroke or systemic embolism in AF patients.HRV analysis in SR may help to improve risk stratification in AF patients.