Evidence suggests an association between autonomical nervous system (ANS) function
and atrial fibrillation (AF) development. We sought to examine the association of
baseline resting heart rate (RHR) and short-term heart rate variability (HRV) as surrogates
of (ANS) with incident AF in individuals without previous cardiovascular disease.
A total of 6,261 participants of the Multi-Ethnic Study of Atherosclerosis who were
free of AF and diagnosed cardiovascular disease were enrolled. Three standard 10-second,
12-lead electrocardiograms (ECG) were used to measure RHR, the standard deviation
of normal-to-normal intervals (SDNN) and the root mean square of successive differences
in RR intervals (RMSSD). Cox proportional hazards models adjusted for demographics,
atrioventricular nodal agents, and known cardiovascular risk factors were used to
examine the association of baseline RHR, and log transformed SDNN and RMSDD with incident
AF. Over a mean follow-up of 11.3 ± 3.7 years, 754 (12%) participants developed AF.
Spline curve analysis revealed a nonlinear association between RHR, HRV, and incident
AF. In fully adjusted models higher (but not lower) baseline RHR (RHR >76 beats/min)
was associated with incident AF (hazard ratio 1.48 95% confidence interval 1.18 to
1.86). Additionally, lower values of RMSDD and SDNN and higher values of RMSDD were
independently associated with incident AF. In conclusion, cardiac ANS dysregulation
indicated as higher RHR and lower HRV is associated with incident AF independent of
known cardiovascular risk factors.
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Article info
Publication history
Published online: September 06, 2019
Received in revised form:
August 12,
2019
Received:
July 4,
2019
Footnotes
Funding: This research was supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute (NHLBI), by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from NCATS, and by grant R01 HL127659 from NHLBI. This work was additionally supported by American Heart Association grant 16EIA26410001 (Alonso).
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