Heart Rate Variability Triangular Index as a Predictor of Cardiovascular Mortality in Patients With Atrial Fibrillation

Abstract

Background Impaired heart rate variability (HRV) is associated with increased mortality in sinus rhythm. However, HRV has not been systematically assessed in patients with atrial fibrillation (AF). We hypothesized that parameters of HRV may be predictive of cardiovascular death in patients with AF. Methods and Results From the multicenter prospective Swiss‐AF (Swiss Atrial Fibrillation) Cohort Study, we enrolled 1922 patients who were in sinus rhythm or AF. Resting ECG recordings of 5‐minute duration were obtained at baseline. Standard parameters of HRV (HRV triangular index, SD of the normal‐to‐normal intervals, square root of the mean squared differences of successive normal‐to‐normal intervals and mean heart rate) were calculated. During follow‐up, an end point committee adjudicated each cause of death. During a mean follow‐up time of 2.6±1.0 years, 143 (7.4%) patients died; 92 deaths were attributable to cardiovascular reasons. In a Cox regression model including multiple covariates (age, sex, body mass index, smoking status, history of diabetes mellitus, history of hypertension, history of stroke/transient ischemic attack, history of myocardial infarction, antiarrhythmic drugs including β blockers, oral anticoagulation), a decreased HRV index ≤ median (14.29), but not other HRV parameters, was associated with an increase in the risk of cardiovascular death (hazard ratio, 1.7; 95% CI, 1.1–2.6; P =0.01) and all‐cause death (hazard ratio, 1.42; 95% CI, 1.02–1.98; P =0.04). Conclusions The HRV index measured in a single 5‐minute ECG recording in a cohort of patients with AF is an independent predictor of cardiovascular mortality. HRV analysis in patients with AF might be a valuable tool for further risk stratification to guide patient management. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02105844.

Describing heart rate variability in patients with chronic atrial fibrillation during hospitalization for COVID‐19

“…AF itself is marked by high HRV, which is secondary to the pattern of AV conduction in AF by influencing the conduction properties of the AV node 24‐26 . Reduced HRV in patients with AF has been shown to be an independent predictor of cardiovascular and all‐cause mortality 27 . Multiple reports have described new‐onset AF in patients diagnosed with COVID‐19, but the electrophysiologic impact of COVID‐19 in patients with established cAF has not been described 28,29 .…”

Association between Cardiac Autonomic Neuropathy and Coronary Artery Lesions in Patients with Type 2 Diabetes

“…There is increasing evidence that reduced HRV may be related to worse cardiovascular outcome among patients with type 2 diabetes [ 16 , 17 ]. However, little is known regarding the relationship between the severities of coronary artery lesions and CAN in patients with type 2 diabetes.…”

Association of Heart Rate Variability With Silent Brain Infarcts in Patients With Atrial Fibrillation

“…Second, multivariable analyses were done by including a set of covariates determined via expert opinion and experience: age, sex, systolic blood pressure, and history of hypertension, history of diabetes, history of heart failure, prior myocardial infarction, prior major bleeding, prior pulmonary vein isolation (PVI) and intake of oral anticoagulation, antiarrhythmic drugs and beta-blockers. We prospectively dichotomized HRVI at 15 according to data of St George's Postinfarction Research Survey Programme and according to previously published data of our Swiss-AF cohort (8,15), SDNN at 70 ms according to the ATRAMI cut-off (3), that was also used in the GISSI-2 study (16,17), MHR at 80 bpm according to the ESC guidelines for the management of AF (11,18) and rMSSD at 42 ms as published previously (19). Frequency domain measures of HRV were log-transformed.…”