4 years ago

Impaired Cardiac Autonomic Regulation and Long-Term Risk of Atrial Fibrillation in Patients With Coronary Artery Disease

The influence of autonomic cardiac regulation on long-term risk of new-onset atrial fibrillation (AF) in coronary artery disease (CAD) is not well established. Objective To evaluate the value of heart rate variability (HRV), a marker of cardiac autonomic regulation, in predicting new-onset AF in CAD. Methods The Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study population consisted of 1,946 patients with CAD. After exclusions, the present analysis included 1,710 patients. The patients had a 24-hour electrocardiographic recording at baseline. Results A total of 143 (8.4%) cases of new-onset AF were observed during the 5.6 ± 1.5 years of follow-up. Decreased values of the short-term scaling exponent of the detrended fluctuation analysis (DFA1) and the ratio of the low-frequency and high-frequency components of the power spectrum (LF/HF ratio) remained the strongest HRV predictors of the development of AF after relevant adjustments in Cox multivariate regression analysis (p<0.001 for both). The accuracy of these parameters in prediction of AF was even better (area under the curve from the receiver operating characteristics curve [AUC]) = 0.630 and 0.631, respectively) than that of echocardiographic left atrial (LA) diameter (AUC = 0.618). Including DFA1 and LF/HF ratio in the AF risk model increased the C-index from 0.630 (95% CI 0.569-0.692) to 0.666 (95% CI 0.612-0.720). Conclusion Impaired cardiac autonomic regulation measured by DFA1 and LF/HF ratio predicts the development of new-onset AF as well as or even better than LA diameter in patients with CAD.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117312353

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