Key result
A risk score combining age >60 years and abnormal autonomic function parameters strongly predicted new-onset atrial fibrillation in post-MI patients (HR 7.0, P<0.001 for a score of 3-4 points).
Why the study?
Do autonomic dysfunction parameters predict new-onset atrial fibrillation in patients with left ventricular systolic dysfunction after acute myocardial infarction?
Cohort (n=271)
Do autonomic dysfunction parameters predict new-onset atrial fibrillation in patients with left ventricular systolic dysfunction after acute myocardial infarction?
Autonomic dysfunction parameters derived from Holter monitoring, combined with age, can strongly predict the development of new-onset atrial fibrillation in post-MI patients with reduced LVEF.
Answers are grounded in this paper and cite their sources.
May aid post-MI AF risk stratification via age and autonomic markers; hypothesis-generating and requires prospective validation.
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.
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Jøns et al. (2010) conducted a cohort in Acute myocardial infarction with left ventricular systolic dysfunction (n=271). Abnormal heart rate variability and turbulence parameters vs. Normal parameters was evaluated on New-onset atrial fibrillation (HR 7.0, p=<0.001). A risk score combining age >60 years and abnormal autonomic function parameters strongly predicted new-onset atrial fibrillation in post-MI patients (HR 7.0, P<0.001 for a score of 3-4 points).
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