Abstract P503: Continuous Diurnal Patterns of Atrial Fibrillation Onset by Chronic Kidney Disease Status: The Atherosclerosis Risk in Communities (aric) Study

Abstract

Background: Chronic kidney disease (CKD) is associated with atrial fibrillation (AF); however, most studies have looked at its presence or occurrence as a dichotomous outcome, and diurnal patterns of AF by CKD status have not yet been characterized. Methods: Of 2257 adults (71-94 years) who underwent 2 weeks of non-invasive continuous heart rhythm monitoring using the Zio XT Patch, we examined 61 participants with paroxysmal AF and characterized the probability of AF onset over the course of 24 hours using a generalized function-on-scalar regression model. CKD status was defined using eGFR and albuminuria. Results: The median device wear-time was 13.7 (12.6, 13.9) days, and the majority (57%) had CKD. In non-CKD, the probability of AF onset fluctuated over 24 hours with two nadir periods occurring in late morning (~10am) and late evening (~10pm), and somewhat prominent peaks occurring in early morning (~8am) and early evening (~6pm) [figure] . Overall, CKD had a higher probability of AF compared to non-CKD. CKD also demonstrated a less pronounced nadir in late evening, and was significantly more likely to experience AF during this time (OR 2.80; 95% CI 1.05, 11.94) compared to non-CKD. This observation was consistent even after adjusting for various potential confounders such as age, sex, race, diabetes, and a history of cardiovascular disease. Conclusion: Based on 2-week monitoring, AF onset seems to exhibit a diurnal pattern throughout the day with peaks in the early morning and evening, and nadir in late morning and evening. Compared to those without CKD, those with CKD are more likely to experience AF in late evening, suggesting a potential high-risk time window for monitoring. Further studies are needed to evaluate prognostic value of AF diurnal patterns.