Jonathan Kim1, Wendy Wang2, Faye L Norby2, Michael Zhang3, Alvaro Alonso4, Pamela L Lutsey2, Elsayed Z Soliman5, Julian Wolfson6, Lin Y Chen3. 1. Division of Biostatistics, School of Public Health, University of Minnesota, A460 Mayo Building, MMC 303, 420 Delaware St. SE, Minneapolis, MN, 55455, United States. Electronic address: kim00225@umn.edu. 2. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 300 West Bank Office Building, 1300 S. 2(nd) St., Minneapolis, MN 55454, United States. 3. Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, MMC 508, 420 Delaware St. SE, Minneapolis, MN 55455, United States. 4. Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, United States. 5. Department of Epidemiology, Division of Public Health Sciences, Wake Forest University School of Medicine, 475 Vine St., Winston-Salem, North Carolina 27101, United States. 6. Division of Biostatistics, School of Public Health, University of Minnesota, A460 Mayo Building, MMC 303, 420 Delaware St. SE, Minneapolis, MN, 55455, United States.
Abstract
BACKGROUND: Paroxysmal atrial fibrillation (AF) is challenging to diagnose due to its intermittent nature. Circadian rhythmicity has been reported for cardiovascular events such as myocardial infarction; whether diurnal variation exists for paroxysmal AF is less known. We characterized the temporal pattern of AF initiation in the Atherosclerosis Risk in Communities (ARIC) study, a prospective community-based cohort study. METHODS: We included 74 ARIC study participants with paroxysmal AF detected by the Zio XT Patch at ARIC Visit 6 in 2016-17. We divided each participant's 2-week continuous monitoring data into 3-h intervals and summed the number of AF episodes in each interval. We performed Poisson regression using generalized estimating equations to estimate the effect of time of day on the number of AF episodes. RESULTS: Compared to the reference interval of time 00:00-02:59, the time intervals 12:00-14:59, 15:00-17:59, and 18:00-20:59 had significantly higher frequency of AF initiation. Rate ratios (95% CI) for mean number of episodes in these three intervals were 1.91 (1.11, 2.92), 2.54 (1.42, 4.53), and 1.99 (1.19, 3.25) respectively. Furthermore, we found no significant association between duration of episode and time of day. CONCLUSION: There is diurnal variation in the initiation of AF episodes, with a peak in frequency in the late afternoon. Our finding is consistent with sympathetically driven AF. Pulse palpation or obtaining an electrocardiogram in the late afternoon may produce the highest diagnostic yield for AF.
BACKGROUND: Paroxysmal atrial fibrillation (AF) is challenging to diagnose due to its intermittent nature. Circadian rhythmicity has been reported for cardiovascular events such as myocardial infarction; whether diurnal variation exists for paroxysmal AF is less known. We characterized the temporal pattern of AF initiation in the Atherosclerosis Risk in Communities (ARIC) study, a prospective community-based cohort study. METHODS: We included 74 ARIC study participants with paroxysmal AF detected by the Zio XT Patch at ARIC Visit 6 in 2016-17. We divided each participant's 2-week continuous monitoring data into 3-h intervals and summed the number of AF episodes in each interval. We performed Poisson regression using generalized estimating equations to estimate the effect of time of day on the number of AF episodes. RESULTS: Compared to the reference interval of time 00:00-02:59, the time intervals 12:00-14:59, 15:00-17:59, and 18:00-20:59 had significantly higher frequency of AF initiation. Rate ratios (95% CI) for mean number of episodes in these three intervals were 1.91 (1.11, 2.92), 2.54 (1.42, 4.53), and 1.99 (1.19, 3.25) respectively. Furthermore, we found no significant association between duration of episode and time of day. CONCLUSION: There is diurnal variation in the initiation of AF episodes, with a peak in frequency in the late afternoon. Our finding is consistent with sympathetically driven AF. Pulse palpation or obtaining an electrocardiogram in the late afternoon may produce the highest diagnostic yield for AF.
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