Agarwal Sunil K, Norby Faye L, Whitsel Eric A, Soliman Elsayed Z, Chen Lin Y, Loehr Laura R, Fuster Valentin, Heiss Gerardo, Coresh Josef, Alonso Alvaro
Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York; Division of General Internal Medicine and Epidemiology, Johns Hopkins University, Baltimore, Maryland.
Department of Epidemiology and Cardiology, University of Minnesota, Minneapolis, Minnesota.
J Am Coll Cardiol. 2017 Jan 24;69(3):291-299. doi: 10.1016/j.jacc.2016.10.059.
Cardiac autonomic perturbations frequently antecede onset of paroxysmal atrial fibrillation (AF). Interventions that influence autonomic inputs to myocardium may prevent AF. However, whether low heart rate or heart rate variability (HRV), which are noninvasive measures of cardiac autonomic dysfunction, are associated with AF incidence is unclear.
This study sought to study the association between HRV and risk of AF.
This study included 11,715 middle-aged adults in the ARIC (Atherosclerosis Risk In Communities) cohort with heart rate and HRV measures obtained from 2-min electrocardiogram recordings performed at baseline (1987 to 1989). These measures included SD of normal-to-normal RR intervals, high-frequency (HF) (0.15 to 0.40 Hz), low-frequency (0.04 to 0.15 Hz), and the low-frequency/HF ratio (denoting a greater sympathetic to parasympathetic dominance). Incident AF cases were ascertained by electrocardiogram at ARIC follow-up visits, hospital discharge diagnosis, or death certificates through 2011.
During an average follow-up of 19.4 years, 1,580 or 13.5% of participants developed AF. A baseline heart rate <60 beats/min was associated modestly with an increased risk of AF. Lower overall HRV as well as increased sympathetic/parasympathetic tone were associated independently with a higher risk of AF; the hazard ratio for each 1 SD lower SD of normal-to-normal RR intervals was 1.14 (95% confidence interval: 1.08 to 1.21), for HF was 1.12 (95% confidence interval: 1.06 to 1.17), and for low frequency/HF was 1.08 (95% confidence interval: 1.03 to 1.14).
Cardiac autonomic dysfunction denoted by low resting short-term HRV was associated with higher AF incidence. A low heart rate may be associated with higher AF risk. Further studies are needed to determine whether interventions in the general population to restore autonomic balance may prevent AF.
心脏自主神经紊乱常常先于阵发性心房颤动（AF）发作。影响心肌自主神经输入的干预措施可能预防房颤。然而，心率或心率变异性（HRV）作为心脏自主神经功能障碍的无创测量指标，是否与房颤发病率相关尚不清楚。
本研究旨在探讨HRV与房颤风险之间的关联。
本研究纳入了社区动脉粥样硬化风险（ARIC）队列中的11715名中年成年人，在基线（1987年至1989年）通过2分钟心电图记录获得心率和HRV测量值。这些测量指标包括正常RR间期的标准差、高频（HF）（0.15至0.40Hz）、低频（0.04至0.15Hz）以及低频/高频比值（表示交感神经对副交感神经优势更大）。通过2011年ARIC随访时的心电图、出院诊断或死亡证明确定房颤病例。
在平均19.4年的随访期间，1580名（13.5%）参与者发生了房颤。基线心率<60次/分钟与房颤风险适度增加相关。总体HRV降低以及交感神经/副交感神经张力增加均与较高的房颤风险独立相关；正常RR间期标准差每降低1个标准差，风险比为1.14（95%置信区间：1.08至1.21），HF为1.12（95%置信区间：1.06至1.17），低频/高频为1.08（95%置信区间：1.03至1.14）。
静息短期HRV降低所表示的心脏自主神经功能障碍与较高的房颤发病率相关。低心率可能与较高的房颤风险相关。需要进一步研究以确定在一般人群中恢复自主神经平衡的干预措施是否可以预防房颤。
