Cardiac Autonomic Dysfunction and Incidence of Atrial Fibrillation: Results From 20 Years Follow-Up.
Cardiac Autonomic Dysfunction and Incidence of Atrial Fibrillation: Results From 20 Years Follow-Up.
复制标题
心房颤动的心脏自主神经功能障碍和发生率：随访20年。
DOI：
10.1016/j.jacc.2016.10.059
复制
发表时间：
2017-01-24
影响因子：
24
通讯作者：
Alonso A
中科院分区：
文献类型：
--
作者：
Agarwal SK;Norby FL;Whitsel EA;Soliman EZ;Chen LY;Loehr LR;Fuster V;Heiss G;Coresh J;Alonso A
心脏自主神经紊乱常常先于阵发性心房颤动 (AF) 的发作。影响心肌自主神经输入的干预措施可能会预防 AF。然而，低心率或心率变异性（HRV）（心脏自主神经功能障碍的无创测量）是否与房颤发生率相关尚不清楚。我们试图研究 HRV 与 AF 风险之间的关联。我们研究了 ARIC（社区动脉粥样硬化风险）队列中的 11,715 名中年成年人，他们的心率和 HRV 测量值是从基线（1987 年至 1989 年）进行的 2 分钟心电图 (ECG) 记录中获得的。这些测量包括 RR 间期的标准差 (SDNN)、高频 (HF)（0.15 至 0.40 Hz）、低频 (LF)（0.04 至 0.15 Hz）和 LF/HF 比率（表示交感神经与副交感神经的优势较高）。截至 2011 年，通过 ARIC 随访时的心电图、出院诊断或死亡证明来确定发生 AF 病例。在平均 19.4 年的随访期间，1,580 名参与者（13.5%）发生了 AF。基线心率<60 次/分钟与 AF 风险增加有一定相关性。较低的整体 HRV 以及增加的交感/副交感神经张力与较高的 AF 风险独立相关； SDNN 每降低 1 个 SD，风险比为 1.14（95% 置信区间 [CI]：1.08 至 1.21），HF 为 1.12（95% CI：1.06 至 1.17），LF/HF 为 1.08（95% CI：1.03 至 1.14）。以低静息短期 HRV 为代表的心脏自主神经功能障碍与较高的 AF 发生率相关。此外，低心率可能与较高的房颤风险相关。需要进一步的研究来确定对普通人群恢复自主神经平衡的干预措施是否可以预防房颤。
Cardiac autonomic perturbations frequently antecede onset of paroxysmal atrial fibrillation (AF). Interventions that influence autonomic inputs to myocardium may prevent AF. However, whether low heart rate or heart rate variability (HRV), which are noninvasive measures of cardiac autonomic dysfunction, are associated with AF incidence is unclear. We sought to study the association between HRV and risk of AF. We studied 11,715 middle-aged adults in the ARIC (Atherosclerosis Risk in Communities) cohort with heart rate and HRV measures obtained from 2-min electrocardiogram (ECG) recordings performed at baseline (1987 to 1989). These measures included standard deviation of RR intervals (SDNN), high frequency (HF) (0.15 to 0.40 Hz), low frequency (LF) (0.04 to 0.15 Hz), and the LF/HF ratio (denoting a higher sympathetic to parasympathetic dominance). Incident AF cases were ascertained by ECG at ARIC follow-up visits, hospital discharge diagnosis, or death certificates through 2011. During an average follow-up of 19.4 years, 1,580 or 13.5% of participants developed AF. A baseline heart rate <60 beats/min was modestly associated with increased AF risk. Lower overall HRV as well as increased sympathetic/parasympathetic tone were independently associated with higher risk of AF; the hazard ratio for each 1 SD lower SDNN was 1.14 (95% confidence interval [CI]: 1.08 to 1.21), for HF was 1.12 (95% CI: 1.06 to 1.17), and for LF/HF was 1.08 (95% CI: 1.03 to 1.14). Cardiac autonomic dysfunction denoted by low resting short-term HRV was associated with higher AF incidence. Also, a low heart rate may be associated with higher AF risk. Further studies are needed to determine whether interventions in the general population to restore autonomic balance may prevent AF.