Beta-blocker use was associated with a significantly higher risk of developing new-onset atrial fibrillation (HR 3.72; 95% CI 2.32-5.96; p<0.001).
Cohort
Does a lower resting heart rate or beta-blocker use increase the risk of new-onset atrial fibrillation in at-risk subjects?
Lower resting heart rates (<75 bpm) and beta-blocker use are associated with higher BNP levels and an increased risk of incident atrial fibrillation.
Effect estimate: HR 3.72 (95% CI 2.32-5.96)
Absolute Event Rate: 2.5% vs 0.6%
p-value: p=<0.001
Background: Lower heart rates (HRs) prolong diastole, which increases filling pressures and wall stress. As a result, lower HRs may be associated with higher brain natriuretic peptide (BNP) levels and incident atrial fibrillation (AF). Beta-blockers may increase the risk for AF due to suppression of resting HRs. Objective: Examine the relationships of HR, BNP, beta-blockers and new-onset AF in the REVEAL-AF and SPRINT cohort of subjects at risk for developing AF. Methods: VASC score of 2.3 ± 1.2 were followed up to 60 months. Results: The median daytime HR in the REVEAL-AF cohort was 75bpm IQR 68-83. Subjects with below-median HRs had 2.4-fold higher BNP levels compared to subjects with above-median HRs (median BNP IQR: 62 pg/dl 37-112 vs. 26 pg/dl 13-53, p < 0.001). HRs <75bpm were associated with a higher incidence of AF: 37% vs. 27%, p < 0.05. This was validated in the SPRINT cohort after adjusting for AF risk factors. Both a HR < 75bpm and beta-blocker use were associated with a higher rate of AF: 1.9 vs 0.7% (p < 0.001) and 2.5% vs. 0.6% (p < 0.001), respectively. The hazard ratio for patients on beta-blockers to develop AF was 3.72 CI 2.32, 5.96, p < 0.001. Conclusions: Lower HRs are associated with higher BNP levels and incident AF, mimicking the hemodynamic effects of diastolic dysfunction. Suppression of resting HR by beta-blockers could explain their association with incident AF.
Habel et al. (Fri,) conducted a cohort in At risk for developing atrial fibrillation. Beta-blockers vs. No beta-blockers was evaluated on New-onset atrial fibrillation (HR 3.72, 95% CI 2.32-5.96, p=<0.001). Beta-blocker use was associated with a significantly higher risk of developing new-onset atrial fibrillation (HR 3.72; 95% CI 2.32-5.96; p<0.001).