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. 2021 Nov;49(11):3000605211057822.
doi: 10.1177/03000605211057822.

Correlation of heart rate recovery and heart rate variability with atrial fibrillation progression

Gwang-Seok Yoon  1 , Seong-Huan Choi  1 , Sung Woo Kwon  1 , Sang-Don Park  1 , Sung-Hee Shin  1 , Seong-Ill Woo  1 , Jun Kwan  1 , Dae-Hyeok Kim  1 , Yong-Soo Baek  1
Affiliations

Correlation of heart rate recovery and heart rate variability with atrial fibrillation progression

Gwang-Seok Yoon et al. J Int Med Res. 2021 Nov.

Abstract

Objective: To examine the combination of heart rate recovery (HRR) and heart rate variability (HRV) in predicting atrial fibrillation (AF) progression.

Methods: Data from patients with a first detected episode of AF who underwent treadmill exercise testing and 24-h Holter electrocardiography were retrospectively analysed. Autonomic dysfunction was verified using HRR values. Sympathetic and parasympathetic modulation was analysed by HRV. AF progression was defined as transition from the first detected paroxysmal episode to persistent/permanent AF.

Results: Of 306 patients, mean LF/HF ratio and HRR did not differ significantly by AF progression regardless of age (< or ≥65 years). However, when the LF/HF ratio was divided into tertiles, in patients aged <65 years, the mid LF/HF (1.60-2.40) ratio was significantly associated with lower AF progression rates and longer maintenance of normal sinus rhythm. For patients aged <65 years, less metabolic equivalents were related to higher AF progression rates. For patients aged ≥65 years, a low HRR was associated with high AF progression rates.

Conclusion: In relatively younger age, high physical capacity and balanced autonomic nervous system regulation are important predictors of AF progression. Evaluation of autonomic function assessed by age could predict AF progression.

Keywords: Atrial fibrillation; Holter electrocardiogram; autonomic function; exercise stress test; heart rate recovery; heart rate variability.

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Conflict of interest statement

Declaration of conflicting interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Percentage of 306 patients with (+) or without (−) AF progression grouped according to METs by tertile, showing: (top) patients aged <65 years (n = 228); and (bottom) patients aged ≥65 years (n = 78). P = 0.049, AF progression (−) versus AF progression (+) in patients aged <65 years (Fisher’s exact test). AF, atrial fibrillation; METs, metabolic equivalents.
Figure 2.
Figure 2.
Percentage of 306 patients with (+) or without (−) AF progression grouped according to LF/HF ratios by tertile, showing: (top) patients aged <65 years (n = 228); and (bottom) patients aged ≥65 years (n = 78). P = 0.039, AF progression (−) versus AF progression (+) in patients aged <65 years (Pearson’s χ2-test). AF, atrial fibrillation; LF, low frequency; HF, high frequency.
Figure 3.
Figure 3.
Sinus rhythm maintenance in 306 patients with (+) or without (−) AF progression grouped according to LF/HF ratio, showing: (top) patients aged <65 years (n = 228); and (bottom) patients aged ≥65 years (n = 78). P = 0.041, LF/HF 1.60–2.40 versus other tertiles (Wilcoxon rank–sum test). AF, atrial fibrillation; LF, low frequency; HF, high frequency.
Figure 4.
Figure 4.
Sinus rhythm maintenance in 306 patients with (+) or without (−) AF progression grouped according to age and METs, showing: (top) patients aged <65 years (n = 228); and (bottom) patients aged ≥65 years (n = 78). P = 0.021, METs ≤10 versus METs >10 (Wilcoxon rank–sum test). AF, atrial fibrillation; METs, metabolic equivalents.
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