Cardiac autonomic function in elderly patients with and without atrial fibrillation

Q: What are the key findings of this study?

Atrial fibrillation during ECG recording was independently associated with a fivefold increase in cardiac autonomic dysfunction (PRD ≥5.75 deg, adjusted OR 5.05, 95% CI 3.86-6.60, p<0.001) vs sinus rhythm.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Atrial fibrillation and cardiac autonomic function (n=2289). Intervention: Atrial fibrillation (AF during ECG recording [AF-AF] and AF in sinus rhythm [AF-SR]) vs. Sinus rhythm without history of AF (SR group). Primary outcome: Cardiac autonomic dysfunction defined as periodic repolarization dynamics (PRD) ≥5.75 deg (AF-AF vs SR reference) (OR 5.05, 95% CI 3.86-6.60, p=<0.001).

Q: What does this research mean for the field?

Atrial fibrillation during ECG recording is independently associated with a fivefold increase in cardiac autonomic dysfunction as measured by periodic repolarization dynamics compared to sinus rhythm. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether cardiac autonomic function, evaluated via heart rate variability and periodic repolarization dynamics, differs between elderly patients with and without atrial fibrillation.

Peter Hämmerle; Johannes Schier; Konstantinos D. Rizas; Vincent Schlageter; Emel Kaplan; Stefanie Aeschbacher; Marius Rast; Philipp Krisai; Michael Coslovsky; Tobias Reichlin; Julia B. Bardoczi; Nicolas Rodondi; Andreas S Müller; Alain Bernheim; Giorgio Moschovitis; Maria Luisa De Perna; David Conen; Christian Sticherling; Stefan Osswald; Axel Bauer; Felix Mahfoud; M Kuhne; Christine S. Zuern

doi:10.1093/ehjopen/oeag056

Key result

AF during ECG linked to ~5-fold higher odds of cardiac autonomic dysfunction vs sinus rhythm.

OR 5.05
95% CI 3.86-6.60
P<0.001
n=2,289

Figures

Graphical abstract published by European Heart Journal Open — Graphical abstract · Published by European Heart Journal Open · CC BY

Why the study?

Cardiac autonomic dysfunction is associated with an adverse prognosis in AF, but whether AF itself is associated with cardiac autonomic function remains unclear.

Does cardiac autonomic function, assessed by periodic repolarization dynamics (PRD) and conventional heart rate variability parameters, differ between elderly patients with and without atrial fibrillation?

Key Points

To determine whether cardiac autonomic function, evaluated via heart rate variability and periodic repolarization dynamics, differs between elderly patients with and without atrial fibrillation.
Prospective multicenter cohort study (Swiss-AF) analyzing 5-minute resting ECG recordings in sinus rhythm or atrial fibrillation without pacing across 2,289 elderly patients.
Patients were categorized into three groups: sinus rhythm controls (n=807), atrial fibrillation patients in sinus rhythm during ECG (n=932), and atrial fibrillation patients actively in atrial fibrillation during ECG (n=550).
Cardiac autonomic function was quantified using periodic repolarization dynamics, reflecting sympathetic activity, alongside conventional heart rate variability measures.
Median periodic repolarization dynamics was 4.8 deg (IQR 2.6–6.7) in sinus rhythm, 5.1 deg (IQR 2.9–6.9) in the atrial fibrillation with sinus rhythm group, and 7.0 deg (IQR 5.8–8.4) in the active atrial fibrillation group (p<0.001).
After multivariable adjustment, active atrial fibrillation showed a pronounced association with elevated periodic repolarization dynamics (β-coefficient 2.10, 95% CI 1.79–2.41, p<0.001), while atrial fibrillation in sinus rhythm showed a modest increase (β-coefficient 0.36, 95% CI 0.08–0.64, p=0.011).
The odds of cardiac autonomic dysfunction (periodic repolarization dynamics ≥5.75 deg) were higher in atrial fibrillation patients presenting in sinus rhythm (OR 1.32, 95% CI 1.06–1.65, p=0.014) and more than fivefold higher in active atrial fibrillation (OR 5.05, 95% CI 3.86–6.60, p<0.001).

Study Design

Type

Cross-Sectional (n=2,289)

Multicenter

Yes

Structured PICO

Does cardiac autonomic function, assessed by periodic repolarization dynamics (PRD) and conventional heart rate variability parameters, differ between elderly patients with and without atrial fibrillation?

P

Population

2,289 elderly patients (mean age ~73 years, 31.4% female) with and without atrial fibrillation from the prospective multicenter Swiss-AF cohort undergoing 5-minute resting high-resolution ECG recordings.

E

Exposure

History of atrial fibrillation presenting in atrial fibrillation (AF-AF group, n=550) or in sinus rhythm (AF-SR group, n=932) during a 5-minute high-resolution 16-lead resting ECG recording

C

Comparator

Patients in sinus rhythm with no history of atrial fibrillation (SR group, n=807) undergoing the same 5-minute resting ECG recording

O

Outcome

Cardiac autonomic function and sympathetic activity quantified by periodic repolarization dynamics (PRD, in degrees, both as a continuous measure and using the primary cut-off of PRD ≥5.75 deg for cardiac autonomic dysfunction) from a 5-minute resting high-resolution 16-lead ECGsurrogate

Main Result

Odds Ratio: 5.05 (95% CI 3.86–6.6)

Absolute Event Rate: 76% vs 38%

p-value: p=<0.001

Atrial fibrillation is independently associated with elevated sympathetic activity measured by periodic repolarization dynamics (PRD), particularly during active AF, establishing PRD as a rhythm-independent marker of cardiac autonomic dysfunction.

Limitations

HRV measures were derived from 5-minute recordings, which may not fully capture long-term autonomic function.
Observational nature and cross-sectional design preclude causal inference regarding the relationship between AF and cardiac autonomic dysfunction.
Secondary explorative analysis of the Swiss-AF cohort study, limiting generalizability to other populations.
Overlap of PRD values among the three groups reflecting interindividual variability.
Residual confounding by unmeasured clinical factors cannot be fully excluded.
HRV measures were derived from 5-min recordings, which may not fully capture long-term autonomic function
Observational nature and cross-sectional design preclude causal inference
Secondary explorative analysis of the Swiss-AF cohort study limiting generalizability
Overlap of PRD values among the three groups reflecting interindividual variability
Potential residual confounding by unmeasured clinical factors

Implication

AF during ECG recording links to higher PRD; hypothesis-generating for autonomic-targeted therapies in elderly AF, pending prospective trials.

Abstract

Structured Abstract Background and 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 We enrolled patients from a prospective multicenter study (Swiss-AF) with a 5-minute resting ECG recording in SR or AF without pacing. CAF was quantified by periodic repolarization dynamics (PRD), a marker of sympathetic activity, and by conventional HRV parameters. Results 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 AF was associated with increased sympathetic activity, with the greatest impairment observed in patients during AF, independent of cardiovascular risk factors. PRD may represent a useful marker for the assessment of CAF in AF patients.

Discussion

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Cite This Study

Hämmerle et al. (2026) conducted a cross-sectional in Atrial fibrillation and cardiac autonomic function (n=2,289). Atrial fibrillation (AF during ECG recording [AF-AF] and AF in sinus rhythm [AF-SR]) vs. Sinus rhythm without history of AF (SR group) was evaluated on Cardiac autonomic dysfunction defined as periodic repolarization dynamics (PRD) ≥5.75 deg (AF-AF vs SR reference) (OR 5.05, 95% CI 3.86-6.60, p=<0.001). Atrial fibrillation during ECG recording was independently associated with a fivefold increase in cardiac autonomic dysfunction (PRD ≥5.75 deg, adjusted OR 5.05, 95% CI 3.86-6.60, p<0.001) vs sinus rhythm.

synapsesocial.com/papers/69d34eac9c07852e0af9845a https://doi.org/10.1093/ehjopen/oeag056

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Cardiac autonomic function in elderly patients with and without atrial fibrillation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Cardiac autonomic function in elderly patients with and without atrial fibrillation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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