A low LF/HF ratio (<1.735) on Holter-ECG within 24 hours of acute myocardial infarction was strongly associated with new-onset atrial fibrillation (OR 3.377; 95% CI 2.047-5.572).
Cohort (n=2,040)
No
Is autonomic dysregulation, measured by heart rate variability, associated with new-onset atrial fibrillation during acute myocardial infarction?
Autonomic dysregulation, indicated by a low LF/HF ratio on early Holter-ECG, is strongly associated with the development of new-onset atrial fibrillation in patients with acute myocardial infarction.
Odds Ratio: 3.377 (95% CI 2.047–5.572)
Background: Atrial fibrillation (AF) is common after acute myocardial infarction (AMI) and associated with in-hospital and long-term mortality. However, the pathophysiology of AF in AMI is poorly understood. Heart rate variability (HRV), measured by Holter-ECG, reflects cardiovascular response to the autonomic nervous system and altered (reduced or enhanced) HRV may have a major role in the onset of AF in AMI patients. Objective: We investigated the relationship between autonomic dysregulation and new-onset AF during AMI. Methods: As part of the RICO survey, all consecutive patients hospitalized for AMI at Dijon (France) university hospital between June 2001 and November 2014 were analyzed by Holter-ECG <24 h following admission. HRV was measured using temporal and spectral analysis. Results: Among the 2040 included patients, 168 (8.2%) developed AF during AMI. Compared to the sinus-rhythm (SR) group, AF patients were older, had more frequent hypertension and lower left ventricular ejection fraction LVEF. On the Holter parameters, AF patients had higher pNN50 values (11% vs. 4%, p < 0.001) and median LH/HF ratio, a reflection of sympathovagal balance, was significantly lower in the AF group (0.88 vs 2.75 p < 0.001). The optimal LF/HF cut-off for AF prediction was 1.735. In multivariate analyses, low LF/HF <1.735 (OR(95%CI) = 3.377 (2.047–5.572)) was strongly associated with AF, ahead of age (OR(95%CI) = 1.04(1.01–1.06)), mean sinus-rhythm rate (OR(95%CI) = 1.03(1.02–1.05)) and log NT-proBNP (OR(95%CI) = 1.38(1.01–1.90). Conclusion: Our study strongly suggests that new-onset AF in AMI mainly occurs in a dysregulated autonomic nervous system, as suggested by low LF/HF, and higher PNN50 and RMSSD values.
Sagnard et al. (Thu,) conducted a cohort in Acute Myocardial Infarction (AMI) (n=2,040). Low LF/HF ratio (<1.735) vs. LF/HF ratio ≥1.735 was evaluated on New-onset atrial fibrillation (AF) during AMI (OR 3.377, 95% CI 2.047-5.572). A low LF/HF ratio (<1.735) on Holter-ECG within 24 hours of acute myocardial infarction was strongly associated with new-onset atrial fibrillation (OR 3.377; 95% CI 2.047-5.572).