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. 2018 Feb 26:18:33-38.
doi: 10.1016/j.ijcha.2018.02.004. eCollection 2018 Mar.

Reduced heart rate response after premature ventricular contraction depending on severity of atrial fibrillation symptoms - Analysis on heart rate turbulence in atrial fibrillation patients

Hisaki Makimoto  1 , Christian Blockhaus  1 , Christian Meyer  1   2 , Tina Lin  3 , Christiane Jungen  1   2 , Christian Eickholt  1   2 , Lukas Clasen  1 , Jan Schmidt  1 , Muhammed Kurt  1 , Patrick Müller  1 , Dong-In Shin  1 , Malte Kelm  1   4 , Alexander Fürnkranz  1
Affiliations

Reduced heart rate response after premature ventricular contraction depending on severity of atrial fibrillation symptoms - Analysis on heart rate turbulence in atrial fibrillation patients

Hisaki Makimoto et al. Int J Cardiol Heart Vasc. .

Abstract

Background: The severity of symptoms during atrial fibrillation (AF) may be influenced by heart rate and blood pressure variation, due to irregular beats and the related adaptations in baroreflex sensitivity. This study investigated whether heart rate turbulence (HRT) as a reflection of baroreflex sensitivity is related to symptom severity during AF.

Method: Ninety-seven patients (pts) who underwent electrophysiological study were enrolled. Consecutive 56 pts had paroxysmal AF (21 with milder symptoms [EHRA I or II; Group-M], 35 with severe symptoms [EHRA III or IV; Group-S]), and 41 age-matched controls without AF were included. After delivering a single ventricular extrastimulus during sinus rhythm and repeating the process 10 times, the quantification of HRT was performed by measuring turbulence onset (TO: heart rate acceleration) and turbulence slope (TS: rate of heart rate deceleration).

Results: Group-M pts showed significantly diminished TO as compared to controls and Group-S pts (P = 0.012). There was no significant difference of the TS between the 3 groups. Given that a TO ≥ 0% or TS ≤ 2.5 ms/RR was considered abnormal, Group-M pts showed significantly higher incidences of abnormal HRT as compared to controls and Group-S pts (71% vs 40% vs 21%, respectively, P = 0.0012). Regression analysis demonstrated an independent and significant association between a diminished TO and milder AF symptoms (P < 0.05).

Conclusions: The usual heart rate acceleration after premature ventricular contraction is significantly diminished in pts with milder AF symptoms as compared to pts with severe AF symptoms. The mechanism of association between this diminished response and symptoms should be further investigated.

Keywords: Atrial fibrillation; Baroreflex sensitivity; Heart rate turbulence; Turbulence onset.

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Figures

Fig. 1
Fig. 1
Turbulence onset of 3 groups. Turbulence onset (TO) in Group-M patients was significantly diminished as compared to that in Group-S or control patients. Group-S patients and controls had no significant difference in TO.
Fig. 2
Fig. 2
Turbulence slope of 3 groups. There was no significant difference in the turbulence slope (TS) among the three groups (Kruskal-Wallis, P = 0.45).
See this image and copyright information in PMC

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