Heart rate variability and recurrence of atrial fibrillation after electrical cardioversion.
- 1 January 2003
- journal article
- research article
- Published by Informa UK Limited in Annals of Medicine
- Vol. 35 (1), 36-42
- https://doi.org/10.1080/07853890310004110
Abstract
BACKGROUND: Heart rate (HR) variability has been shown to predict spontaneous onset of atrial fibrillation (AF). This study was designed to test the hypothesis that HR variability after electrical cardioversion (CV) of persistent AF predicts the recurrence of AF. METHODS: Various time and frequency domain measures of HR variability, along with the non‐linear measures of HR dynamics, were analyzed from the 24‐hour ECG recordings in 78 patients with persistent AF after restoration of sinus rhythm with electrical CV. RESULTS: During the follow‐up of one month, 27 patients (35%) had recurrence of AF. The patients with AF recurrence had significantly higher standard deviation of all R‐R intervals (SDNN 117 ± 34versus100 ± 29P < 0.05), increased high‐frequency (lnHF 5.7 ± 0.6versus5.3 ± 0.7P < 0.05 ), low‐frequency (lnLF 6.2 ± 0.8versus5.6 ± 0.9P < 0.01) and very‐low‐frequency (InVLF 7.1 ± 0.8versus6.5 ± 0.8P < 0.01) power spectral components of HR variability than those who remained in sinus rhythm. Approximate entropy, a measure of complexity of HR dynamics, and the short‐term fractal scaling exponent did not differ between the groups, but the long‐term power‐law slope β was steeper among the patients who remained in sinus rhythm ( P < 0.05). During the first week after the CV, increased HF power (highest tertile) was the most powerful predictor of AF recurrence with odds ratio of 2.8 (95% confidence interval 1.0 to 8.0,P < 0.05). Increased VLF power spectral component at baseline predicted best the late recurrence of AF with odds ratio of 3.3 (95% confidence interval 1.6 to 7.2,P < 0.01). No clinical or echocardiographic variable predicted the recurrence of AF. CONCLUSIONS: Increased HR variability in all major power spectral bands is associated with late recurrence of AF after electrical CV. Enhanced cardiac vagal outflow, reflected as an increased HF power spectral component, seems to predict specifically the early recurrence of AF after the CV.Keywords
This publication has 27 references indexed in Scilit:
- Tachycardia Induced Electrical Remodeling of the Atria and the Autonomic Nervous System in GoatsPacing and Clinical Electrophysiology, 1999
- Atrial fibrillation: current knowledge and recommendations for management*1European Heart Journal, 1998
- Cardioversion of Atrial Fibrillation and Subsequent Maintenance of Sinus RbythmPacing and Clinical Electrophysiology, 1997
- Influence of metoprolol on heart rate variability in survivors of remote myocardial infarctionThe American Journal of Cardiology, 1996
- Maintenance of Atrial Fibrillation in Anesthetized and Unanesthetized Sheep Using Cholinergic DrivePacing and Clinical Electrophysiology, 1996
- Increased dispersion of “refractoriness” in patients with idiopathic paroxysmal atrial fibrillationJournal of the American College of Cardiology, 1992
- Effect of atenolol and diltiazem on heart period variability in normal personsJournal of the American College of Cardiology, 1991
- Factors determining maintenance of sinus rhythm after chronic atrial fibrillation with left atrial dilatationThe American Journal of Cardiology, 1989
- Echocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillationThe American Journal of Cardiology, 1989
- Echocardiographic Left Atrial Dimension as a Predictor of Maintaining Sinus Rhythm after Conversion of Atrial FibrillationActa Medica Scandinavica, 1985