Predictive value of heart rate variability for the recurrence of chronic atrial fibrillation after electrical cardioversion

Abstract

SummaryBackground: The relation between heart rate variability (HRV) and occurrence of atrial fibrillation (AF) in paroxysmal AF has been well studied, but there are controversial observations regarding the relation of HRV parameters to the recurrence of chronic AF after cardioversion.Hypothesis: The present study compared HRV parameters of patients with chronic AF on the second day of cardioversion with a healthy control group and investigated their predictive value for AF recurrence.Methods: Forty-one patients with chronic AF (> 3 months), who had various underlying cardiovascular disorders, were enrolled to the study. Of these, 31 patients were successfully cardioverted by external direct current shock, but 27 patients fulfilled the entry criteria. Twenty healthy subjects served as a control group. On the second day of restoration of sinus rhythm, 24-h Holter recording was obtained and the following time-domain indices of HRV were measured: SDNN (the standard deviation of the mean RR interval expressed in ms), SDANN (the SD of the averages of RR intervals in all 5-min segments of the 24-h recording), rMSSD (the root mean square of differences of successive RR intervals), and pNN50 (the percentage of adjacent RR intervals that differed by more than 50 ms). Patients were followed-up for 6 weeks for recurrence of AF.

Autonomic modulation of the sinus node following electrical cardioversion of persistent atrial fibrillation: relation with early recurrence

“…Although a relationship between HRV parameters and atrial electrophysiological properties has been proposed by many clinical studies [4,5,[11][12][13][14], it remains to be established to what extent the HRV of the sinus node correlates to changes in atrial autonomic tone.…”

“…A comparison of our results in terms of predictive value of HRV analysis with results of previous studies is quite impossible. In fact, the HRV analyses were often obtained during a 24-h ECG Holter recording performed in the first [11][12][13] or in the second 24 h [14] after AF interruption. Moreover, the results of HRV analysis were used to predict late AF recurrence [11][12][13][14].…”

Modulation of Cardiac Autonomic Nervous Activity Early after Cardioversion of Atrial Fibrillation by Biphasic Waveform

“…Changes in autonomic balance seem to play a role in the pathogenesis of arrhythmias following electrical CV and might have a predictive value 1 . The suppression of parasympathetic activity is associated with ERAF after CV 5,9 . Although previous studies have shown that cardiac autonomic activity is modified by electrical CV and predicts the relapse of AF, it seems unlikely that the waveform applied has an effect on late recurrences of AF 10,11 .…”

“…1 The suppression of parasympathetic activity is associated with ERAF after CV. 5,9 Although previous studies have shown that cardiac autonomic activity is modified by electrical CV and predicts the relapse of AF, it seems unlikely that the waveform applied has an effect on late recurrences of AF. 10,11 According to our results, HRV is markedly depressed after Mo CV as opposed to Bi CV.…”

Relation Between Variability of Ventricular Response Intervals and Exercise Capacity in Patients With Non-Valvular Atrial Fibrillation

“…1 With regard to treatment, the heart rate control strategy is as effective as the rhythm control strategy, 2,3 but the target heart rate in this strategy is as yet unclear, although the heart rate during AF may be related to the prognosis and/or the quality of the patient's life. A heart rate less than 90 beats/min at rest and 115 beats/min during moderate exercise has been recommended, 4 but is based on clinical experience.…”