Wang Weijia, Alonso Alvaro, Soliman Elsayed Z, O'Neal Wesley T, Calkins Hugh, Chen Lin Yee, Diener-West Marie, Szklo Moyses
The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Emory University Rollins School of Public Health, Atlanta, Georgia.
Am J Cardiol. 2018 May 15;121(10):1169-1176. doi: 10.1016/j.amjcard.2018.01.037. Epub 2018 Feb 21.
The evidence on the association between resting heart rate (HR) and incident atrial fibrillation (AF) is conflicting. Whether change in resting HR is associated with incident AF is unknown. We evaluated 11,545 participants (mean [±standard deviation] age: 57 ± 5.7 years) free of AF at baseline (1990 to 1992). Resting HR was obtained from 10-second electrocardiograms at baseline and 3 years later. AF diagnosis was ascertained from visit electrocardiograms, hospital discharge records, and death certificates through 2013. High and low resting HR were defined as ≥80 and <55 beats/min, respectively. Increase and decrease in HR were defined as a 3-year HR difference >15 and <-15 beats/min, respectively. Over a median follow-up of 22.5 years, 1,746 (15%) participants developed AF. Both baseline high resting HR and increase in HR were independently associated with incident AF (hazard ratio = 1.2, 95% confidence interval = 1.0 to 1.5 and hazard ratio = 1.4, 95% confidence interval = 1.1 to 1.9). Increase in HR was no longer associated with incident AF after additional adjustment for incident heart failure. In stratified analyses, increase in HR was associated only with AF in participants <60 years, with bachelor's degree or above, without diabetes, and without hypertension (p values for interaction ≤0.05). In conclusion, in a middle-aged population, high resting HR is associated with higher AF risk. Increase in resting HR is also associated with higher AF risk, especially in individuals without traditional AF risk factors. Whether interventions to decrease HR can prevent AF remain to be examined.
静息心率（HR）与新发房颤（AF）之间关联的证据存在矛盾。静息心率的变化是否与新发房颤相关尚不清楚。我们评估了11545名在基线时（1990年至1992年）无房颤的参与者（平均[±标准差]年龄：57±5.7岁）。在基线时和3年后从10秒心电图中获取静息心率。通过2013年的就诊心电图、医院出院记录和死亡证明来确定房颤诊断。高静息心率和低静息心率分别定义为≥80次/分钟和<55次/分钟。心率增加和降低分别定义为3年内心率差值>15次/分钟和<-15次/分钟。在中位随访22.5年期间，1746名（15%）参与者发生了房颤。基线高静息心率和心率增加均与新发房颤独立相关（风险比=1.2，95%置信区间=1.0至1.5；风险比=1.4，95%置信区间=1.1至1.9）。在对新发心力衰竭进行额外调整后，心率增加与新发房颤不再相关。在分层分析中，心率增加仅与年龄<60岁、具有学士学位及以上、无糖尿病且无高血压的参与者的房颤相关（交互作用的P值≤0.05）。总之，在中年人群中，高静息心率与较高的房颤风险相关。静息心率增加也与较高的房颤风险相关，尤其是在没有传统房颤危险因素的个体中。降低心率的干预措施是否能预防房颤仍有待研究。
