Association between atrial fibrillatory rate and heart rate variability in patients with atrial fibrillation and congestive heart failure

Abstract

Background: Even if atrial fibrillatory rate (AFR) has been related to clinical outcome in patients with atrial fibrillation (AF), its relation with ventricular response has not been deeply studied. The aim of this study was to investigate the relation between AFR and RR series variability in patients with AF.

Methods: Twenty-minute electrocardiograms in orthogonal leads were processed to extract AFR, using spatiotemporal QRST cancellation and time frequency analysis, and RR series in 127 patients (age 69 ± 11 years) with congestive heart failure (NYHA II-III) enrolled in the MUSIC study (MUerte Subita en Insufficiencia Cardiaca). Heart rate variability and irregularity were assessed by time domain parameters and entropy-based indices, respectively and their correlation with AFR investigated.

Results: Variability measures seem not to be related to AFR, while irregularity measures do. A significant correlation between AFR and variability parameters of heart rate variability during AF was found only in patients not treated with antiarrhythmics drugs (correlation = 0.56 P < 0.05 for pNN50), while this correlation was lost in patients taking rate- or rhythm-control drugs. A significant positive correlation between AFR and indices of RR irregularity was found, showing that a higher AFR is related to a less organized RR series (correlation = 0.33 P < 0.05 for regularity index for all patients, correlation increased in subgroups of patients treated with the same drug).

Conclusions: These results suggest that a higher AFR is associated with a higher degree of irregularity of ventricular response that is observed regardless of the use of rate-controlling drugs.

Figure 1

Scatterplots of heart rate variability and irregularity parameters versus AFR for all patients; the linear fitting is superimposed (dashed line). Values of Person's correlation are shown in each subplot. AFR = atrial fibrillation rate; HR = ventricular rate; SDNN = standard deviation of all normal RR intervals; rMSSD = the root of the mean squared differences of successive RR intervals; pNN20, pNN50, pNN80 = the percentage of interval differences of successive RR intervals greater than 20ms, 50ms and 80ms; ApEn = approximate entropy; R = regularity index. *P < 0.05.

Figure 2

Scatterplots of heart rate variability and irregularity parameters versus AFR for the patients who were not taking antiarrhythmic drugs; the linear fitting is superimposed (dashed line). Values of Person's correlation are shown in each subplot. AFR = atrial fibrillation rate; HR = ventricular rate; SDNN = standard deviation of all normal RR intervals; rMSSD = the root of the mean squared differences of successive RR intervals; pNN20, pNN50, pNN80 = the percentage of interval differences of successive RR intervals greater than 20 ms, 50 ms, and 80 ms; ApEn = approximate entropy; R = regularity index. *P < 0.05.

Figure 3

Scatterplots of heart rate variability and irregularity parameters versus AFR for the patients taking rhythm‐control drug; the linear fitting is superimposed (dashed line). Values of Person's correlation are shown in each subplot. AFR = atrial fibrillation rate; HR = ventricular rate; SDNN = standard deviation of all normal RR intervals; rMSSD = the root of the mean squared differences of successive RR intervals; pNN20, pNN50, pNN80 = the percentage of interval differences of successive RR intervals greater than 20 ms, 50 ms, and 80 ms; ApEn = approximate entropy; R = regularity index. *P < 0.05.

Figure 4

Scatterplots of heart rate variability and irregularity parameters versus AFR for the patients taking rate‐control drug; the linear fitting is superimposed (dashed line). Values of Person's correlation are shown in each subplot. AFR = atrial fibrillation rate; HR = ventricular rate; SDNN = standard deviation of all normal RR intervals; rMSSD = the root of the mean squared differences of successive RR intervals; pNN20, pNN50, pNN80 = the percentage of interval differences of successive RR intervals greater than 20 ms, 50 ms, and 80 ms; ApEn = approximate entropy; R = regularity index. *P < 0.05.