Heart rate variability and stroke or systemic embolism in patients with atrial fibrillation
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
Abstract
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: The purpose of this study was to test the hypothesis that impaired cardiac autonomic function might be associated with an enhanced stroke risk in AF patients. METHODS: A total of 1922 AF patients who were in either sinus rhythm (SR group; n = 1121) or AF (AF group; n = 801) on a 5-minute resting electrocardiographic (ECG) recording were enrolled in the study. Heart rate variability 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-minute total power, and power in the high-frequency, low-frequency, and very-low-frequency ranges were calculated. Cox regression models were constructed to examine the association of heart rate variability (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 years in the AF group. Thirty-seven patients in the SR group (3.4%) and 60 patients in the AF group (8.0%) experienced a stroke or systemic embolism during follow-up 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 = .009) after adjustment for multiple confounders. In the AF group, no HRV parameter was found 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.