November 1, 2021Journal of International Medical ResearchOpen Access

Correlation of heart rate recovery and heart rate variability with atrial fibrillation progression

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Why the study?

To examine the combination of heart rate recovery and heart rate variability in predicting atrial fibrillation progression.

Do heart rate recovery and heart rate variability predict atrial fibrillation progression in patients with a first detected episode of AF?

Structured PICO

Do heart rate recovery and heart rate variability predict atrial fibrillation progression in patients with a first detected episode of AF?

Population

306 consecutive patients with a first detected episode of atrial fibrillation (AF) who underwent treadmill exercise testing and 24-h Holter monitoring. Mean age 55.4 years, 27.8% female, based in the Republic of Korea. Key exclusions: high-grade atrioventricular blocks, severe hypertension, uncontrolled symptomatic heart failure, unstable angina, and inability to exercise.

Intervention

Assessment of heart rate recovery (HRR) via treadmill exercise testing and heart rate variability (HRV) via 24-h Holter monitoring.

Comparator

Comparison across different tertiles of LF/HF ratio, metabolic equivalents (METs), and HRR values.

Outcome

AF progression (defined as transition from the first detected paroxysmal episode to persistent or permanent AF) over a mean follow-up of 46.7 months.surrogate

Evaluation of autonomic function via heart rate recovery and heart rate variability can help predict the progression of atrial fibrillation, with age-specific prognostic markers.

Implication

Should not yet use combined HRR-HRV to predict AF progression; leaves open prospective validation of age-specific autonomic markers.

Abstract

OBJECTIVE: To examine the combination of heart rate recovery (HRR) and heart rate variability (HRV) in predicting atrial fibrillation (AF) progression. METHODS: Data from patients with a first detected episode of AF who underwent treadmill exercise testing and 24-h Holter electrocardiography were retrospectively analysed. Autonomic dysfunction was verified using HRR values. Sympathetic and parasympathetic modulation was analysed by HRV. AF progression was defined as transition from the first detected paroxysmal episode to persistent/permanent AF. RESULTS: Of 306 patients, mean LF/HF ratio and HRR did not differ significantly by AF progression regardless of age (< or ≥65 years). However, when the LF/HF ratio was divided into tertiles, in patients aged <65 years, the mid LF/HF (1.60-2.40) ratio was significantly associated with lower AF progression rates and longer maintenance of normal sinus rhythm. For patients aged <65 years, less metabolic equivalents were related to higher AF progression rates. For patients aged ≥65 years, a low HRR was associated with high AF progression rates. CONCLUSION: In relatively younger age, high physical capacity and balanced autonomic nervous system regulation are important predictors of AF progression. Evaluation of autonomic function assessed by age could predict AF progression.