BACKGROUND: Atrial fibrillation (AF) increases morbidity and mortality in patients with previous myocardial infarction and left ventricular systolic dysfunction. The purpose of this study was to identify patients with a high risk for new-onset AF in this population using invasive and noninvasive electrophysiological tests. METHODS: The study included 271 patients from the Cardiac Arrhythmias and RIsk Stratification after Myocardial InfArction (CARISMA) study with an acute myocardial infarction (AMI) and left ventricular ejection fraction ≤40% without previous AF at enrollment. Within 21 days after the AMI, an implantable loop recorder was inserted and used to diagnose AF over the 2-year study duration. The following tests were performed: heart rate variability (HRV) and turbulence (HRT) analyses from repeated 24-hour Holter recordings, 2-dimensional (2D)-echocardiograms, exercise test, and programmed electrophysiologic stimulation. RESULTS: A total of 101 patients (37%) developed AF during the study. Predictive measures included several indexes of HRV including reduced low-frequency (LF) power from spectral HRV analysis (adjusted HR = 1.6, P = 0.034), HRT slope ≤2.5 (HR = 1.6, P = 0.032) and Detrended Fluctuation Analysis (DFA1) from HRV analysis (HR = 1.8, P = 0.011); all are measures of cardiac autonomic nervous system dysfunction. Combined with age >60 years, low values for LF, HRT slope, and DFA1 provided a powerful risk score for prediction of new-onset AF (1-2 points: HR = 4.3, P = 0.001, 3-4 points: HR = 7.0, P < 0.001). CONCLUSION: Abnormal HRV and HRT parameters, which are associated with disturbances in the cardiac autonomic regulation, are associated with increased risk of new-onset AF independently of conventional clinical risk variables.
BACKGROUND:Atrial fibrillation (AF) increases morbidity and mortality in patients with previous myocardial infarction and left ventricular systolic dysfunction. The purpose of this study was to identify patients with a high risk for new-onset AF in this population using invasive and noninvasive electrophysiological tests. METHODS: The study included 271 patients from the Cardiac Arrhythmias and RIsk Stratification after Myocardial InfArction (CARISMA) study with an acute myocardial infarction (AMI) and left ventricular ejection fraction ≤40% without previous AF at enrollment. Within 21 days after the AMI, an implantable loop recorder was inserted and used to diagnose AF over the 2-year study duration. The following tests were performed: heart rate variability (HRV) and turbulence (HRT) analyses from repeated 24-hour Holter recordings, 2-dimensional (2D)-echocardiograms, exercise test, and programmed electrophysiologic stimulation. RESULTS: A total of 101 patients (37%) developed AF during the study. Predictive measures included several indexes of HRV including reduced low-frequency (LF) power from spectral HRV analysis (adjusted HR = 1.6, P = 0.034), HRT slope ≤2.5 (HR = 1.6, P = 0.032) and Detrended Fluctuation Analysis (DFA1) from HRV analysis (HR = 1.8, P = 0.011); all are measures of cardiac autonomic nervous system dysfunction. Combined with age >60 years, low values for LF, HRT slope, and DFA1 provided a powerful risk score for prediction of new-onset AF (1-2 points: HR = 4.3, P = 0.001, 3-4 points: HR = 7.0, P < 0.001). CONCLUSION: Abnormal HRV and HRT parameters, which are associated with disturbances in the cardiac autonomic regulation, are associated with increased risk of new-onset AF independently of conventional clinical risk variables.
Authors: Paulus Kirchhof; Gregory Y H Lip; Isabelle C Van Gelder; Jeroen Bax; Elaine Hylek; Stefan Kaab; Ulrich Schotten; Karl Wegscheider; Giuseppe Boriani; Axel Brandes; Michael Ezekowitz; Hans Diener; Laurent Haegeli; Hein Heidbuchel; Deirdre Lane; Luis Mont; Stephan Willems; Paul Dorian; Maria Aunes-Jansson; Carina Blomstrom-Lundqvist; Maria Borentain; Stefanie Breitenstein; Martina Brueckmann; Nilo Cater; Andreas Clemens; Dobromir Dobrev; Sergio Dubner; Nils G Edvardsson; Leif Friberg; Andreas Goette; Michele Gulizia; Robert Hatala; Jenny Horwood; Lukas Szumowski; Lukas Kappenberger; Josef Kautzner; Angelika Leute; Trudie Lobban; Ralf Meyer; Jay Millerhagen; John Morgan; Felix Muenzel; Michael Nabauer; Christoph Baertels; Michael Oeff; Dieter Paar; Juergen Polifka; Ursula Ravens; Ludger Rosin; W Stegink; Gerhard Steinbeck; Panos Vardas; Alphons Vincent; Maureen Walter; Günter Breithardt; A John Camm Journal: Europace Date: 2011-07-26 Impact factor: 5.214
Authors: Manel Ben Halima; Wael Yaakoubi; Selim Boudiche; Bassem Rekik; Fathia Zghal Mghaieth; Sana Ouali; Mohamed Sami Mourali Journal: Tunis Med Date: 2022 fevrier
Authors: Peter Hanna; Eric Buch; Stavros Stavrakis; Christian Meyer; John D Tompkins; Jeffrey L Ardell; Kalyanam Shivkumar Journal: Cardiovasc Res Date: 2021-06-16 Impact factor: 10.787