Key result
Milder atrial fibrillation symptoms were associated with a significantly higher incidence of abnormal heart rate turbulence compared to controls and severe symptoms (71% vs 40% vs 21%, P=0.0012).
Why the study?
Does heart rate turbulence correlate with symptom severity in patients with paroxysmal atrial fibrillation?
Observational (n=97)
Does heart rate turbulence correlate with symptom severity in patients with paroxysmal atrial fibrillation?
Absolute Event Rate: 71% vs 21%
p-value: p=0.0012
Diminished heart rate acceleration after premature ventricular contraction is associated with milder symptoms in patients with paroxysmal atrial fibrillation, suggesting a role for baroreflex sensitivity in symptom perception.
Abnormal HRT may relate to milder paroxysmal AF symptoms; hypothesis-generating for baroreflex sensitivity, requiring prospective validation.
BACKGROUND: The severity of symptoms during atrial fibrillation (AF) may be influenced by heart rate and blood pressure variation, due to irregular beats and the related adaptations in baroreflex sensitivity. This study investigated whether heart rate turbulence (HRT) as a reflection of baroreflex sensitivity is related to symptom severity during AF. METHOD: Ninety-seven patients (pts) who underwent electrophysiological study were enrolled. Consecutive 56 pts had paroxysmal AF (21 with milder symptoms [EHRA I or II; Group-M], 35 with severe symptoms [EHRA III or IV; Group-S]), and 41 age-matched controls without AF were included. After delivering a single ventricular extrastimulus during sinus rhythm and repeating the process 10 times, the quantification of HRT was performed by measuring turbulence onset (TO: heart rate acceleration) and turbulence slope (TS: rate of heart rate deceleration). RESULTS: Group-M pts showed significantly diminished TO as compared to controls and Group-S pts (P = 0.012). There was no significant difference of the TS between the 3 groups. Given that a TO ≥ 0% or TS ≤ 2.5 ms/RR was considered abnormal, Group-M pts showed significantly higher incidences of abnormal HRT as compared to controls and Group-S pts (71% vs 40% vs 21%, respectively, P = 0.0012). Regression analysis demonstrated an independent and significant association between a diminished TO and milder AF symptoms (P < 0.05). CONCLUSIONS: The usual heart rate acceleration after premature ventricular contraction is significantly diminished in pts with milder AF symptoms as compared to pts with severe AF symptoms. The mechanism of association between this diminished response and symptoms should be further investigated.
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Makimoto et al. (2018) conducted an observational in Atrial fibrillation (n=97). Milder atrial fibrillation symptoms (EHRA I or II) vs. Severe atrial fibrillation symptoms (EHRA III or IV) and controls without AF was evaluated on Abnormal heart rate turbulence (turbulence onset ≥ 0% or turbulence slope ≤ 2.5 ms/RR) (p=0.0012). Milder atrial fibrillation symptoms were associated with a significantly higher incidence of abnormal heart rate turbulence compared to controls and severe symptoms (71% vs 40% vs 21%, P=0.0012).
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