What does this research mean for the field?

Atrial fibrillation is independently associated with increased sympathetic activity and cardiac autonomic impairment, with the greatest dysfunction observed during active atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to clarify the differences in cardiac autonomic function between elderly patients with and without atrial fibrillation.

May 22, 2026Open Access

Cardiac autonomic function in elderly patients with and without atrial fibrillation.

Key Points

This research aims to clarify the differences in cardiac autonomic function between elderly patients with and without atrial fibrillation.
Prospective multicentre study (Swiss-AF) with 2289 enrolled patients.

Structured PICO

Does atrial fibrillation alter cardiac autonomic function as assessed by periodic repolarization dynamics and heart rate variability in elderly patients?

Population

2,289 elderly patients from a prospective multicentre study (Swiss-AF) with a 5-min resting ECG recording in sinus rhythm (SR) or atrial fibrillation (AF) without pacing. Includes 807 SR patients (mean age 74, 37% female), 932 AF patients with SR ECGs (AF-SR, mean age 70, 31% female), and 550 AF patients with AF ECGs (AF-AF, mean age 75, 24% female).

Intervention

Atrial fibrillation (AF-AF and AF-SR groups)

Comparator

Sinus rhythm without history of AF (SR reference group)

Outcome

Cardiac autonomic function quantified by periodic repolarization dynamics (PRD) and conventional heart rate variability (HRV) parameters from a 5-min resting ECGsurrogate

Atrial fibrillation is associated with increased sympathetic activity, with the greatest impairment observed during active AF, suggesting periodic repolarization dynamics is a useful marker for assessing cardiac autonomic function.

Abstract

Aims Cardiac autonomic dysfunction is associated with an adverse prognosis in patients with atrial fibrillation (AF). However, the association of AF itself with cardiac autonomic function (CAF) remains unclear. We aimed to investigate whether CAF, assessed by heart rate variability (HRV), differs across patients with and without AF.Methods And Results We enrolled patients from a prospective multicentre study (Swiss-AF) with a 5-min resting ECG recording in SR or AF without pacing. Cardiac autonomic function was quantified by periodic repolarization dynamics (PRD), a marker of sympathetic activity, and by conventional HRV parameters. We included 2289 patients, 807 (35%) SR patients, 932 (41%) AF patients with SR ECGs (AF-SR), and 550 (24%) AF patients with AF ECGs (AF-AF). Mean age was 74 vs. 70 vs. 75 years; 37%, 31%, and 24% were female. Median PRD was 4.8 deg (IQR 2.6-6.7) in the SR group, 5.1 deg (IQR 2.9-6.9) in the AF-SR group, and 7.0 deg (IQR 5.8-8.4) in the AF-AF group (P < 0.001). After full adjustment (SR group = reference group), the AF-AF group showed a stronger association with elevated PRD (β-coefficient 2.10, 95% CI 1.79-2.41, P < 0.001) than the AF-SR group (β-coefficient 0.36, 95% CI 0.08-0.64, P = 0.011). Most other HRV parameters indicated greater autonomic impairment in the AF-SR group compared to the SR group.Conclusion Atrial fibrillation was associated with increased sympathetic activity, with the greatest impairment observed in patients during AF, independent of cardiovascular risk factors. Periodic repolarization dynamics may represent a useful marker for the assessment of CAF in AF patients.

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