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Paroksismal Atriyal Fibrilasyonun Öngördürücüleri: Kalp Hızı Değişkenliği ve Kalp Hızı Türbülansı

Year 2022, Volume: 12 Issue: 1, 65 - 70, 01.04.2022

Abstract

Amaç: Otonomik disfonksiyon, atriyal fibrilasyon (AF) gelişmesine ve tekrarlamasına en büyük sebep olan faktörlerden biridir. Risk faktörleri olan hastalarda kalp hızı değişkenliği (KHD) ve kalp hızı türbülansı (KHT) gibi otonomik disfonksiyon parametrelerini kullanarak AF’yi tahmin etmek günlük pratiğimizi etkileyebilir. Bu çalışmada, paroksismal AF (PAF) hastaları ve sağlıklı denekler arasında 24 saatlik Holter EKG’den elde edilen KHD ve KHT ölçümlerini karşılaştırmayı amaçladık.
Materyal ve Metot: Bu vaka-kontrol çalışmasına toplam 116 hasta dahil edildi. Tüm hastalara 24 saatlik Holter EKG monitörizasyonu yapıldı. KHD (VLF, LF, HF, SDNN, SDANN, ASDNN, rMSSD, pNN50) ve KHT parametreleri [türbülans başlangıcı (TO) ve türbülans eğimi (TS)] analiz edildi ve gruplar arasında karşılaştırıldı. Tüm katılımcılar KHT parametrelerine göre üç gruba ayrıldı (KHT-0: normal TO, TS; KHT-1; anormal TO veya TS; KHT-2: anormal TO ve TS).
Bulgular: PAF’lı hastalarda tüm KHD parametrelerinin bozulduğu bulundu (tüm parametreler için p<0,05). TO (PAF: 1,23±2,56; kontrol: -1,02±1,35; p= <0,001) ve TS (PAF: 2,59±2,39; kontrol: 3,75±1,49; p=0,002) değerlerinde gruplar arasında istatistiksel olarak anlamlı fark vardı. Ayrıca PAF hastalarının %62’si HRT-2 grubunda iken sağlıklı denekler ağırlıklı olarak HRT-0 grubundaydı (%79).
Sonuç: Anormal KHD ve KHT değerleri, artan PAF riskini yansıtabilir. Hem TS hem de TO bozuk olan hastalar yakından izlenmelidir. AF’nin olası komplikasyonları, invaziv olmayan, tekrarlanabilir, kolay erişilebilir 24 saatlik EKG Holter monitörizasyonu kullanılarak erken teşhis ve uygun tedavi ile önlenebilir.

References

  • 1. Veenhuyzen GD, Simpson CS, Abdollah H. Atrial fibrillation. CMAJ. 2004;171:755–60.
  • 2. Viskin S, Golovner M, Malov N, Fish R, Alroy I, Vila Y, et al. Circadian variation of symptomatic paroxysmal atrial fibrillation. Data from almost 10000 episodes. Eur Heart J. 1999;20(19):1429–34.
  • 3. Candemir M, Candemir B, Ertürk A. Evaluation of cardiac autonomic nervous system in patients with ankylosing spondylitis using 12-lead electrocardiography and Holter monitoring. Clin Rheumatol. 2020;39(9):2631–9.
  • 4. Candemir M, Onder H. Assessing Autonomic Nervous Function by Heart Rate Variability and Heart Rate Turbulence in Patients with Acute Ischemic Stroke. Ann Indian Acad Neurol. 2020;23:608–15.
  • 5. Disertori M, Mase M, Rigoni M, Nollo G, Ravelli F. Heart Rate Turbulence Is a Powerful Predictor of Cardiac Death and Ventricular Arrhythmias in Postmyocardial Infarction and Heart Failure Patients: A Systematic Review and Meta-Analysis. Circ Arrhythm Electrophysiol. 2016;9(12): e004610.
  • 6. Makimoto H, Blockhaus C, Meyer C, Lin T, Jungen C, Eickholt C, et al. Reduced heart rate response after premature ventricular contraction depending on severity of atrial fibrillation symptoms - Analysis on heart rate turbulence in atrial fibrillation patients. Int J Cardiol Heart Vasc. 2018;18:33–8.
  • 7. Vikman S, Lindgren K, Mäkikallio TH, Yli-Mäyry S, Airaksinen KEJ, Huikuri HV. Heart rate turbulence after atrial premature beats before spontaneous onset of atrial fibrillation. J Am Coll Cardiol. 2005;45(2):278–84.
  • 8. Gallo C, Bocchino PP, Magnano M, Gaido L, Zema D, Battaglia A, et al. Autonomic Tone Activity Before the Onset of Atrial Fibrillation. J Cardiovasc Electrophysiology. 2017;28(3):304–14.
  • 9. Bauer A, Malik M, Schmidt G, Barthel P, Bonnemeier H, Cygankiewicz I, et al. Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus. J Am Coll Cardiol. 2008;52(17):1353–65.
  • 10. Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659–66.
  • 11. Olshansky B. Interrelationships between the autonomic nervous system and atrial fibrillation. Prog Cardiovasc Dis. 2005;48(1):57–78.
  • 12. Chen PS, Chen LS, Fishbein MC, Lin SF, Nattel S. Role of the autonomic nervous system in atrial fibrillation: pathophysiology and therapy. Circ Res. 2014;114(9):1500–15.
  • 13. Komatsu T, Nakamura S, Suzuki O, Horiuchi D, Yomogida K, Okumura K. Long-term prognosis of patients with paroxysmal atrial fibrillation depends on their response to antiarrhythmic therapy. Circ J. 2004;68(8):729–33.
  • 14. Steinberg BA, Hellkamp AS, Lokhnygina Y, Patel MR, Breithardt G, Hankey GJ, et al. Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial. Eur Heart J. 2015;36(5):288–96.
  • 15. Vanassche T, Lauw MN, Eikelboom JW, Healey JS, Hart RG, Alings M, et al. Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES. Eur Heart J. 2015;36(5):281–7a.
  • 16. Vlachos K, Letsas KP, Korantzopoulos P, Liu T, Georgopoulos S, Bakalakos A, et al. Prediction of atrial fibrillation development and progression: Current perspectives. World J Cardiol. 2016;8(3):267–76.
  • 17. Israel CW, Gronefeld G, Ehrlich JR, Li YG, Hohnloser SH. Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: implications for optimal patient care. J Am Coll Cardiol. 2004;43(1):47–52.
  • 18. Page RL, Wilkinson WE, Clair WK, McCarthy EA, Pritchett EL. Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. Circulation. 1994;89(1):224–7.
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  • 20. Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Frontiers Pub Health. 2017;5:258.
  • 21. Pumprla J, Howorka K, Groves D, Chester M, Nolan J. Functional assessment of heart rate variability: physiological basis and practical applications. Int J Cardiol. 2002;84(1):1–14.
  • 22. Agarwal SK, Norby FL, Whitsel EA, Soliman EZ, Chen LY, Loehr LR, et al. Cardiac Autonomic Dysfunction and Incidence of Atrial Fibrillation: Results From 20 Years Follow-Up. J Am Coll Cardiol. 2017;69(3):291–9.
  • 23. Maheshwari A, Norby FL, Soliman EZ, Adabag S, Whitsel EA, Alonso A, et al. Low Heart Rate Variability in a 2-Minute Electrocardiogram Recording Is Associated with an Increased Risk of Sudden Cardiac Death in the General Population: The Atherosclerosis Risk in Communities Study. PLoS One. 2016;11(8): e0161648.
  • 24. Butta C, Tuttolomondo A, Casuccio A, Petrantoni R, Miceli G, Cuttitta F, et al. Relationship between HRV measurements and demographic and clinical variables in a population of patients with atrial fibrillation. Heart Vessels. 2016;31(12):2004–13.
  • 25. Park J, Lee S, Jeon M. Atrial fibrillation detection by heart rate variability in Poincare plot. Biomed Eng Online. 2009;8:38.
  • 26. Vikman S, Makikallio TH, Yli-Mayry S, Nurmi M, Airaksinen KE, Huikuri HV. Heart rate variability and recurrence of atrial fibrillation after electrical cardioversion. Ann Med. 2003;35(1):36–42.
  • 27. Sulimov V, Okisheva E, Tsaregorodtsev D. Non-invasive risk stratification for sudden cardiac death by heart rate turbulence and microvolt T-wave alternans in patients after myocardial infarction. Europace. 2012;14(12):1786–92.
  • 28. Schmidt G, Morfill GE, Barthel P, Hadamitzky M, Kreuzberg H, Demmel V, et al. Variability of ventricular premature complexes and mortality risk. Pacing Clin Electrophysiol. 1996;19(6):976–80.

Predictors of Paroxysmal Atrial Fibrillation: Heart Rate Variability and Heart Rate Turbulence

Year 2022, Volume: 12 Issue: 1, 65 - 70, 01.04.2022

Abstract

Aim: Autonomic dysfunction is one of the major contributors to atrial fibrillation (AF) development and recurrence. Predicting AF using autonomic dysfunction parameters such as heart rate variability (HRV) and heart rate turbulence (HRT) in patients with risk factors may influence our daily practice. Thus we compare HRV and HRT measurements derived from 24 hours Holter ECG between paroxysmal AF (PAF) patients and healthy subjects.
Material and Method: A total number of 116 patients were included in this case-control study. All patients underwent a 24-h Holter ECG monitoring. HRV (VLF, LF, HF, SDNN, SDANN, ASDNN, rMSSD, pNN50) and HRT parameters [turbulence onset (TO) and turbulence slope (TS)] were analyzed and compared between groups. According to their HRT parameters, all participants were divided into three groups (HRT-0: normal TO, TS; HRT-1; abnormal TO or TS; HRT-2: abnormal TO and TS). A p-value <0.05 was considered significant.
Results: All HRV parameters were impaired in patients with PAF (p<0.05 for all parameters). There was a statistically significant difference between groups in TO (PAF 1.23±2.56; control -1.02±1.35; p= <0.001) and TS (PAF 2.59±2.39; control 3.75±1.49; p=0.002) values. In addition, 62% of the PAF patients were in HRT-2 group, on contrary; healthy subjects were predominantly in HRT-0 group (79%).
Conclusion: Abnormal HRV and HRT values may reflect an increased risk of PAF. Patients should be closely monitored when both TS and TO are impaired. AF’s potential complications may be prevented by early detection and proper treatment using non-invasive, reproducible, easily accessible 24-h ECG Holter monitoring.

References

  • 1. Veenhuyzen GD, Simpson CS, Abdollah H. Atrial fibrillation. CMAJ. 2004;171:755–60.
  • 2. Viskin S, Golovner M, Malov N, Fish R, Alroy I, Vila Y, et al. Circadian variation of symptomatic paroxysmal atrial fibrillation. Data from almost 10000 episodes. Eur Heart J. 1999;20(19):1429–34.
  • 3. Candemir M, Candemir B, Ertürk A. Evaluation of cardiac autonomic nervous system in patients with ankylosing spondylitis using 12-lead electrocardiography and Holter monitoring. Clin Rheumatol. 2020;39(9):2631–9.
  • 4. Candemir M, Onder H. Assessing Autonomic Nervous Function by Heart Rate Variability and Heart Rate Turbulence in Patients with Acute Ischemic Stroke. Ann Indian Acad Neurol. 2020;23:608–15.
  • 5. Disertori M, Mase M, Rigoni M, Nollo G, Ravelli F. Heart Rate Turbulence Is a Powerful Predictor of Cardiac Death and Ventricular Arrhythmias in Postmyocardial Infarction and Heart Failure Patients: A Systematic Review and Meta-Analysis. Circ Arrhythm Electrophysiol. 2016;9(12): e004610.
  • 6. Makimoto H, Blockhaus C, Meyer C, Lin T, Jungen C, Eickholt C, et al. Reduced heart rate response after premature ventricular contraction depending on severity of atrial fibrillation symptoms - Analysis on heart rate turbulence in atrial fibrillation patients. Int J Cardiol Heart Vasc. 2018;18:33–8.
  • 7. Vikman S, Lindgren K, Mäkikallio TH, Yli-Mäyry S, Airaksinen KEJ, Huikuri HV. Heart rate turbulence after atrial premature beats before spontaneous onset of atrial fibrillation. J Am Coll Cardiol. 2005;45(2):278–84.
  • 8. Gallo C, Bocchino PP, Magnano M, Gaido L, Zema D, Battaglia A, et al. Autonomic Tone Activity Before the Onset of Atrial Fibrillation. J Cardiovasc Electrophysiology. 2017;28(3):304–14.
  • 9. Bauer A, Malik M, Schmidt G, Barthel P, Bonnemeier H, Cygankiewicz I, et al. Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus. J Am Coll Cardiol. 2008;52(17):1353–65.
  • 10. Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659–66.
  • 11. Olshansky B. Interrelationships between the autonomic nervous system and atrial fibrillation. Prog Cardiovasc Dis. 2005;48(1):57–78.
  • 12. Chen PS, Chen LS, Fishbein MC, Lin SF, Nattel S. Role of the autonomic nervous system in atrial fibrillation: pathophysiology and therapy. Circ Res. 2014;114(9):1500–15.
  • 13. Komatsu T, Nakamura S, Suzuki O, Horiuchi D, Yomogida K, Okumura K. Long-term prognosis of patients with paroxysmal atrial fibrillation depends on their response to antiarrhythmic therapy. Circ J. 2004;68(8):729–33.
  • 14. Steinberg BA, Hellkamp AS, Lokhnygina Y, Patel MR, Breithardt G, Hankey GJ, et al. Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial. Eur Heart J. 2015;36(5):288–96.
  • 15. Vanassche T, Lauw MN, Eikelboom JW, Healey JS, Hart RG, Alings M, et al. Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES. Eur Heart J. 2015;36(5):281–7a.
  • 16. Vlachos K, Letsas KP, Korantzopoulos P, Liu T, Georgopoulos S, Bakalakos A, et al. Prediction of atrial fibrillation development and progression: Current perspectives. World J Cardiol. 2016;8(3):267–76.
  • 17. Israel CW, Gronefeld G, Ehrlich JR, Li YG, Hohnloser SH. Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: implications for optimal patient care. J Am Coll Cardiol. 2004;43(1):47–52.
  • 18. Page RL, Wilkinson WE, Clair WK, McCarthy EA, Pritchett EL. Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. Circulation. 1994;89(1):224–7.
  • 19. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996;17(3):354–81.
  • 20. Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Frontiers Pub Health. 2017;5:258.
  • 21. Pumprla J, Howorka K, Groves D, Chester M, Nolan J. Functional assessment of heart rate variability: physiological basis and practical applications. Int J Cardiol. 2002;84(1):1–14.
  • 22. Agarwal SK, Norby FL, Whitsel EA, Soliman EZ, Chen LY, Loehr LR, et al. Cardiac Autonomic Dysfunction and Incidence of Atrial Fibrillation: Results From 20 Years Follow-Up. J Am Coll Cardiol. 2017;69(3):291–9.
  • 23. Maheshwari A, Norby FL, Soliman EZ, Adabag S, Whitsel EA, Alonso A, et al. Low Heart Rate Variability in a 2-Minute Electrocardiogram Recording Is Associated with an Increased Risk of Sudden Cardiac Death in the General Population: The Atherosclerosis Risk in Communities Study. PLoS One. 2016;11(8): e0161648.
  • 24. Butta C, Tuttolomondo A, Casuccio A, Petrantoni R, Miceli G, Cuttitta F, et al. Relationship between HRV measurements and demographic and clinical variables in a population of patients with atrial fibrillation. Heart Vessels. 2016;31(12):2004–13.
  • 25. Park J, Lee S, Jeon M. Atrial fibrillation detection by heart rate variability in Poincare plot. Biomed Eng Online. 2009;8:38.
  • 26. Vikman S, Makikallio TH, Yli-Mayry S, Nurmi M, Airaksinen KE, Huikuri HV. Heart rate variability and recurrence of atrial fibrillation after electrical cardioversion. Ann Med. 2003;35(1):36–42.
  • 27. Sulimov V, Okisheva E, Tsaregorodtsev D. Non-invasive risk stratification for sudden cardiac death by heart rate turbulence and microvolt T-wave alternans in patients after myocardial infarction. Europace. 2012;14(12):1786–92.
  • 28. Schmidt G, Morfill GE, Barthel P, Hadamitzky M, Kreuzberg H, Demmel V, et al. Variability of ventricular premature complexes and mortality risk. Pacing Clin Electrophysiol. 1996;19(6):976–80.
There are 28 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Mustafa Candemir This is me

Burak Sezenöz This is me

Murat Özdemir This is me

Publication Date April 1, 2022
Published in Issue Year 2022 Volume: 12 Issue: 1

Cite

APA Candemir, M., Sezenöz, B., & Özdemir, M. (2022). Predictors of Paroxysmal Atrial Fibrillation: Heart Rate Variability and Heart Rate Turbulence. Kafkas Journal of Medical Sciences, 12(1), 65-70.
AMA Candemir M, Sezenöz B, Özdemir M. Predictors of Paroxysmal Atrial Fibrillation: Heart Rate Variability and Heart Rate Turbulence. KAFKAS TIP BİL DERG. April 2022;12(1):65-70.
Chicago Candemir, Mustafa, Burak Sezenöz, and Murat Özdemir. “Predictors of Paroxysmal Atrial Fibrillation: Heart Rate Variability and Heart Rate Turbulence”. Kafkas Journal of Medical Sciences 12, no. 1 (April 2022): 65-70.
EndNote Candemir M, Sezenöz B, Özdemir M (April 1, 2022) Predictors of Paroxysmal Atrial Fibrillation: Heart Rate Variability and Heart Rate Turbulence. Kafkas Journal of Medical Sciences 12 1 65–70.
IEEE M. Candemir, B. Sezenöz, and M. Özdemir, “Predictors of Paroxysmal Atrial Fibrillation: Heart Rate Variability and Heart Rate Turbulence”, KAFKAS TIP BİL DERG, vol. 12, no. 1, pp. 65–70, 2022.
ISNAD Candemir, Mustafa et al. “Predictors of Paroxysmal Atrial Fibrillation: Heart Rate Variability and Heart Rate Turbulence”. Kafkas Journal of Medical Sciences 12/1 (April 2022), 65-70.
JAMA Candemir M, Sezenöz B, Özdemir M. Predictors of Paroxysmal Atrial Fibrillation: Heart Rate Variability and Heart Rate Turbulence. KAFKAS TIP BİL DERG. 2022;12:65–70.
MLA Candemir, Mustafa et al. “Predictors of Paroxysmal Atrial Fibrillation: Heart Rate Variability and Heart Rate Turbulence”. Kafkas Journal of Medical Sciences, vol. 12, no. 1, 2022, pp. 65-70.
Vancouver Candemir M, Sezenöz B, Özdemir M. Predictors of Paroxysmal Atrial Fibrillation: Heart Rate Variability and Heart Rate Turbulence. KAFKAS TIP BİL DERG. 2022;12(1):65-70.