Cardiac Autonomic Dysfunction and Incidence of de novo Atrial Fibrillation: Heart Rate Variability vs. Heart Rate Complexity.

Niels Wessel,Jan F Kraemer,Andrej Gapelyuk,Jürgen Kurths,Christof Kolb,Roberto Belke,Stefan Kääb,Dave Wenzel,Karsten Berg,Tino Hauser,Alexander Schirdewan,Norbert Klein,Katrin Rietsch

doi:10.3389/fphys.2020.596844

Abstract

BackgroundThe REACT DX registry evaluates standard therapies to episodes of long-lasting atrial tachyarrhythmias and assesses the quality of sensing and stability of the lead and the implantable cardioverter-defibrillator (ICD) (BIOTRONIK Lumax VR-T DX and successors) over at least a 1-year follow-up period.ObjectiveTo study the association between the risk of de novo device-detected atrial fibrillation (AF), the autonomic perturbations before the onset of paroxysmal AF and a 7-days heart rate variability (7dHRV) 1 month after ICD implantation.MethodsThe registry consists of 234 patients implanted with an ICD, including 10 with de novo long-lasting atrial tachyarrhythmias with no prior history of AF. The patients were matched via the propensity-score methodology as well as for properties directly influencing the ECGs recorded using GE CardioMem CM 3000. Heart rate variability (HRV) analysis was performed using standard parameters from time- and frequency-domains, and from non-linear dynamics.ResultsNo linear HRV was associated with an increased risk of AF (p = n.s.). The only significant approach was derived from symbolic dynamics with the parameter “forbidden words” which distinguished both groups on all 7 days of measurements (p < 0.05), thereby quantifying the heart rate complexity (HRC) as drastically lower in the de novo AF group.ConclusionCardiac autonomic dysfunction denoted by low HRC may be associated with higher AF incidence. For patients with mild to moderate heart failure, standard HRV parameters are not appropriate to quantify cardiac autonomic perturbations before the onset of AF. Further studies are needed to determine the individual risk for AF that would enable interventions to restore autonomic balance in the general population.

Highlights

Atrial fibrillation (AF), the most common clinical arrhythmia, is associated with increased risk of stroke, heart failure (HF) and possibly dementia (Mozaffarian et al, 2016)
The parameter “forbidden words,” significantly distinguished both groups on all 7 days of measurement as performed independently (p < 0.05; the probability for false statistical results is less than 1 to a billion:
The objective of this investigation was to study the association between the risk of de novo AF and 7-day HRV (7dHRV) based of standard time- and frequency-domain parameters as well as from nonlinear dynamics

Summary

Introduction

Atrial fibrillation (AF), the most common clinical arrhythmia, is associated with increased risk of stroke, heart failure (HF) and possibly dementia (Mozaffarian et al, 2016). The e-Cardiology ESC Working Group and the European Heart Rhythm Association co-endorsed by the Asia Pacific Heart Rhythm Society wrote a joint position statement about advances in HRV signal analysis (Sassi et al, 2015). They presented a critical review of newly developed HRV methodologies developed after publication of the initial Task Force HRV overview (Wessel et al, 2016) and their applications in different physiological and clinical studies. The REACT DX registry evaluates standard therapies to episodes of longlasting atrial tachyarrhythmias and assesses the quality of sensing and stability of the lead and the implantable cardioverter-defibrillator (ICD) (BIOTRONIK Lumax VR-T DX and successors) over at least a 1-year follow-up period

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