Wesley T O'Neal1, Waqas T Qureshi2, Michael J Blaha3, Zeina A Dardari3, Jonathan K Ehrman4, Clinton A Brawner4, Elsayed Z Soliman2,5, Mouaz H Al-Mallah4,6. 1. Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. 2. Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. 3. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. 4. Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA. 5. Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA. 6. King Saud bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdul Aziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia.
Abstract
OBJECTIVES: To examine the association between chronotropic incompetence and incident atrial fibrillation (AF). BACKGROUND: Patients with inadequate heart rate response during exercise may have abnormalities in sinus node function or autonomic tone that predispose to the development of AF. METHODS: We examined the association between heart rate response and incident AF in 57,402 (mean age=54±13 years, 47% female, 64% white) patients free of baseline AF who underwent exercise-treadmill stress testing from the Henry Ford ExercIse Testing (FIT) Project. Age-predicted maximum heart rate (pMHR) values <85% and chronotropic index values <80% were used to define chronotropic incompetence. Cox regression, adjusting for demographics, cardiovascular risk factors, medications, coronary heart disease, heart failure, and metabolic equivalent of task achieved, was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between chronotropic incompetence and incident AF. RESULTS: Over a median follow-up of 5.0 years (25th-75th percentiles=2.6, 7.8), a total of 3,395 (5.9%) participants developed AF. pMHR values <85% were associated with an increased risk for AF development (HR=1.33, 95%CI=1.22, 1.44). Chronotropic index values <80% also were associated with an increased risk of AF (HR=1.28, 95%CI=1.19, 1.38). The associations of pMHR and chronotropic index with AF remained significant with varying cut-off points to define chronotropic incompetence. CONCLUSIONS: Our analysis suggests that patients with inadequate heart rate response during exercise have an increased risk for developing AF.
OBJECTIVES: To examine the association between chronotropic incompetence and incident atrial fibrillation (AF). BACKGROUND:Patients with inadequate heart rate response during exercise may have abnormalities in sinus node function or autonomic tone that predispose to the development of AF. METHODS: We examined the association between heart rate response and incident AF in 57,402 (mean age=54±13 years, 47% female, 64% white) patients free of baseline AF who underwent exercise-treadmill stress testing from the Henry Ford ExercIse Testing (FIT) Project. Age-predicted maximum heart rate (pMHR) values <85% and chronotropic index values <80% were used to define chronotropic incompetence. Cox regression, adjusting for demographics, cardiovascular risk factors, medications, coronary heart disease, heart failure, and metabolic equivalent of task achieved, was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between chronotropic incompetence and incident AF. RESULTS: Over a median follow-up of 5.0 years (25th-75th percentiles=2.6, 7.8), a total of 3,395 (5.9%) participants developed AF. pMHR values <85% were associated with an increased risk for AF development (HR=1.33, 95%CI=1.22, 1.44). Chronotropic index values <80% also were associated with an increased risk of AF (HR=1.28, 95%CI=1.19, 1.38). The associations of pMHR and chronotropic index with AF remained significant with varying cut-off points to define chronotropic incompetence. CONCLUSIONS: Our analysis suggests that patients with inadequate heart rate response during exercise have an increased risk for developing AF.
Authors: Michael A Rosenberg; Marlena Maziarz; Alex Y Tan; Nicole L Glazer; Susan J Zieman; Jorge R Kizer; Joachim H Ix; Luc Djousse; David S Siscovick; Susan R Heckbert; Kenneth J Mukamal Journal: Am Heart J Date: 2014-02-26 Impact factor: 4.749
Authors: Mouaz H Al-Mallah; Steven J Keteyian; Clinton A Brawner; Seamus Whelton; Michael J Blaha Journal: Clin Cardiol Date: 2014-08 Impact factor: 2.882
Authors: Irene Grundvold; Per Torger Skretteberg; Knut Liestøl; Gunnar Erikssen; Kristian Engeseth; Knut Gjesdal; Sverre E Kjeldsen; Harald Arnesen; Jan Erikssen; Johan Bodegard Journal: Circ Arrhythm Electrophysiol Date: 2013-07-21
Authors: Kristen K Patton; Patrick T Ellinor; Susan R Heckbert; Robert H Christenson; Christopher DeFilippi; John S Gottdiener; Richard A Kronmal Journal: Circulation Date: 2009-10-19 Impact factor: 29.690
Authors: Sonia Franciosi; Thomas M Roston; Frances K G Perry; Bjorn C Knollmann; Prince J Kannankeril; Shubhayan Sanatani Journal: J Cardiovasc Electrophysiol Date: 2019-07-11
Authors: Jin Kyung Hwang; Hye Bin Gwag; Seung-Jung Park; Young Keun On; June Soo Kim; Kyoung-Min Park Journal: Clin Cardiol Date: 2018-04-17 Impact factor: 2.882