Predictive Value of Heart Rate Variability for the Recurrence of Chronic Atrial Fibrillation After Electrical Cardioversion

Overview

Journal Clin Cardiol

Specialty Cardiology & Vascular Diseases

Date 2003 Apr 24

PMID 12708629

Citations 5

Authors

Omer Akyurek

Erdem Diker

Muharrem Guldal

Dervis Oral

Affiliations

Soon will be listed here.

Abstract

Background: The relation between heart rate variability (HRV) and occurrence of atrial fibrillation (AF) in paroxysmal AF has been well studied, but there are controversial observations regarding the relation of HRV parameters to the recurrence of chronic AF after cardioversion.

Hypothesis: The present study compared HRV parameters of patients with chronic AF on the second day of cardioversion with a healthy control group and investigated their predictive value for AF recurrence.

Methods: Forty-one patients with chronic AF (> 3 months), who had various underlying cardiovascular disorders, were enrolled to the study. Of these, 31 patients were successfully cardioverted by external direct current shock, but 27 patients fulfilled the entry criteria. Twenty healthy subjects served as a control group. On the second day of restoration of sinus rhythm, 24-h Holter recording was obtained and the following time-domain indices of HRV were measured: SDNN (the standard deviation of the mean RR interval expressed in ms), SDANN (the SD of the averages of RR intervals in all 5-min segments of the 24-h recording), rMSSD (the root mean square of differences of successive RR intervals), and pNN50 (the percentage of adjacent RR intervals that differed by more than 50 ms). Patients were followed-up for 6 weeks for recurrence of AF.

Results: After cardioversion, SDNN and SDANN were found to be significantly lower in the AF group than in the control group (86.4 +/- 31.7 ms vs. 142.1 +/- 40.2 ms, and 57 +/- 17.4 ms vs. 124.4 +/- 37.7 ms, p < 0.001 and p < 0.001, respectively). The indices of vagal modulation of heart rate (rMSS and pNN50) were not different between the AF group and the control group. Recurrence of AF was observed in 15 patients. In these patients, all HRV parameters were significantly depressed compared with those with maintained sinus rhythm. Logistic regression analysis revealed that only decreased pNN50 was an independent predictor of AF relapse (relative risk = 1.5, p = 0.02, 95% confidence interval 1.1-2.2). There was also a trend toward a shortened SDNN as a predictor of AF recurrences.

Conclusion: Suppressed HRV parameters and decreased vagal tone are probably a risk factor for AF recurrences after cardioversion to sinus rhythm in a specific subset of patients with chronic AF.

Citing Articles

The autonomic nervous system in atrial fibrillation-pathophysiology and non-invasive assessment.

Vandenberk B, Haemers P, Morillo C Front Cardiovasc Med. 2024; 10:1327387.

PMID: 38239878 PMC: 10794613. DOI: 10.3389/fcvm.2023.1327387.

Heart Rate Variability and Clinical Features as Predictors of Atrial Fibrillation Recurrence After Catheter Ablation: A Pilot Study.

Saiz-Vivo J, Corino V, Hatala R, de Melis M, Mainardi L Front Physiol. 2021; 12:672896.

PMID: 34113264 PMC: 8185295. DOI: 10.3389/fphys.2021.672896.

Novel Method to Efficiently Create an mHealth App: Implementation of a Real-Time Electrocardiogram R Peak Detector.

Gliner V, Behar J, Yaniv Y JMIR Mhealth Uhealth. 2018; 6(5):e118.

PMID: 29789276 PMC: 5989064. DOI: 10.2196/mhealth.8429.

Interdependent Relationship Between Atrial Fibrillation and Sinus Rhythm at the Hypothetical Interface of Atrial Fibrillation, Autonomic Tone, Sinoatrial Node and Inflammation : Analytical Review, Reconsiderations, Speculations and New Insights.

Stirbys P J Atr Fibrillation. 2017; 5(4):613.

PMID: 28496790 PMC: 5153154. DOI: 10.4022/jafib.613.

Potential effects of intrinsic heart pacemaker cell mechanisms on dysrhythmic cardiac action potential firing.

Yaniv Y, Tsutsui K, Lakatta E Front Physiol. 2015; 6:47.

PMID: 25755643 PMC: 4337365. DOI: 10.3389/fphys.2015.00047.

References

Bode F, Wiegand U, Raasch W, Richardt G, Potratz J . Differential effects of defibrillation on systemic and cardiac sympathetic activity. Heart. 1999; 79(6):560-7. PMC: 1728717. DOI: 10.1136/hrt.79.6.560. View

Blaauw Y, Tieleman R, Brouwer J, VAN DEN BERG , de Kam P, DE LANGEN C . Tachycardia induced electrical remodeling of the atria and the autonomic nervous system in goats. Pacing Clin Electrophysiol. 1999; 22(11):1656-67. DOI: 10.1111/j.1540-8159.1999.tb00386.x. View

Kanoupakis E, Manios E, Mavrakis H, Kaleboubas M, Parthenakis F, Vardas P . Relation of autonomic modulation to recurrence of atrial fibrillation following cardioversion. Am J Cardiol. 2000; 86(9):954-8. DOI: 10.1016/s0002-9149(00)01129-2. View

Chang C, Wu T, Zhou S, Doshi R, Lee M, Ohara T . Nerve sprouting and sympathetic hyperinnervation in a canine model of atrial fibrillation produced by prolonged right atrial pacing. Circulation. 2001; 103(1):22-5. DOI: 10.1161/01.cir.103.1.22. View

Lombardi F, Colombo A, Basilico B, Ravaglia R, Garbin M, Vergani D . Heart rate variability and early recurrence of atrial fibrillation after electrical cardioversion. J Am Coll Cardiol. 2001; 37(1):157-62. DOI: 10.1016/s0735-1097(00)01039-1. View

Alessi R, NUSYNOWITZ M, Abildskov J, MOE G . Nonuniform distribution of vagal effects on the atrial refractory period. Am J Physiol. 1958; 194(2):406-10. DOI: 10.1152/ajplegacy.1958.194.2.406. View

BURN J, WILLIAMS E, Walker J . The effects of acetylcholine in the heart-lung preparation including the production of auricular fibrillation. J Physiol. 1955; 128(2):277-93. PMC: 1365858. DOI: 10.1113/jphysiol.1955.sp005306. View

Schiller N, Shah P, Crawford M, DeMaria A, Devereux R, FEIGENBAUM H . Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989; 2(5):358-67. DOI: 10.1016/s0894-7317(89)80014-8. View

Casolo G, Balli E, Taddei T, Amuhasi J, Gori C . Decreased spontaneous heart rate variability in congestive heart failure. Am J Cardiol. 1989; 64(18):1162-7. DOI: 10.1016/0002-9149(89)90871-0. View

10.

Alpert J, Petersen P, Godtfredsen J . Atrial fibrillation: natural history, complications, and management. Annu Rev Med. 1988; 39:41-52. DOI: 10.1146/annurev.me.39.020188.000353. View

11.

Kaseda S, Zipes D . Supersensitivity to acetylcholine of canine sinus and AV nodes after parasympathetic denervation. Am J Physiol. 1988; 255(3 Pt 2):H534-9. DOI: 10.1152/ajpheart.1988.255.3.H534. View

12.

Inoue H, Zipes D . Changes in atrial and ventricular refractoriness and in atrioventricular nodal conduction produced by combinations of vagal and sympathetic stimulation that result in a constant spontaneous sinus cycle length. Circ Res. 1987; 60(6):942-51. DOI: 10.1161/01.res.60.6.942. View

13.

Brand F, Abbott R, Kannel W, Wolf P . Characteristics and prognosis of lone atrial fibrillation. 30-year follow-up in the Framingham Study. JAMA. 1985; 254(24):3449-53. View

14.

Zipes D, Mihalick M, Robbins G . Effects of selective vagal and stellate ganglion stimulation of atrial refractoriness. Cardiovasc Res. 1974; 8(5):647-55. DOI: 10.1093/cvr/8.5.647. View

15.

Buxton A, Waxman H, Marchlinski F, Josephson M . Atrial conduction: effects of extrastimuli with and without atrial dysrhythmias. Am J Cardiol. 1984; 54(7):755-61. DOI: 10.1016/s0002-9149(84)80203-9. View

16.

Waxman M, Wald R, Cameron D . Interactions between the autonomic nervous system and tachycardias in man. Cardiol Clin. 1983; 1(2):143-85. View

17.

Kannel W, Abbott R, Savage D, MCNAMARA P . Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med. 1982; 306(17):1018-22. DOI: 10.1056/NEJM198204293061703. View

18.

Stein P, Bosner M, Kleiger R, Conger B . Heart rate variability: a measure of cardiac autonomic tone. Am Heart J. 1994; 127(5):1376-81. DOI: 10.1016/0002-8703(94)90059-0. View

19.

. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996; 93(5):1043-65. View

20.

Chiou C, Eble J, Zipes D . Efferent vagal innervation of the canine atria and sinus and atrioventricular nodes. The third fat pad. Circulation. 1997; 95(11):2573-84. DOI: 10.1161/01.cir.95.11.2573. View