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Updated: Jun 26, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Heart rate variability and stroke or systemic embolism in patients with atrial fibrillation
Peter Hämmerle1, Stefanie Aeschbacher2, Vincent Schlageter2
1Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Insights
Impaired cardiac autonomic function, measured by heart rate variability triangular index (HRVI) during sinus rhythm (SR), is linked to increased stroke risk in atrial fibrillation (AF) patients. This finding aids in better stroke risk stratification for AF patients.
Area of Science:
- Cardiology
- Autonomic Nervous System Research
- Clinical Electrophysiology
Background:
- Atrial fibrillation (AF) patients face significant stroke risk, often associated with autonomic nervous system disturbances.
- Understanding the link between cardiac autonomic function and stroke in AF is crucial for risk management.
Purpose of the Study:
- To investigate if impaired cardiac autonomic function correlates with a higher risk of stroke in patients with atrial fibrillation.
- To test the hypothesis linking autonomic dysfunction to enhanced stroke risk in AF.
Main Methods:
- 1922 AF patients (1121 in sinus rhythm, 801 in AF) underwent 5-minute ECG recordings.
- Heart rate variability (HRV) parameters, including HRVI, were calculated.
- Cox regression models analyzed the association between HRV and stroke/systemic embolism.
Main Results:
- In patients with sinus rhythm (SR), a low HRVI (<15) was strongly associated with increased stroke/systemic embolism risk (HR 3.04, P=.009).
- No significant association between HRV parameters and stroke/systemic embolism was found in the AF group.
- The study followed 1922 AF patients for 5 years, observing stroke/systemic embolism events.
Conclusions:
- Heart rate variability triangular index (HRVI) during sinus rhythm (SR) independently predicts stroke or systemic embolism in AF patients.
- HRV analysis during SR on a short ECG recording can improve stroke risk stratification in AF.
- This suggests autonomic function assessment during SR is valuable for AF patient management.
Background:
Stroke remains one of the most serious complications in atrial fibrillation (AF) patients and has been linked to disturbances of the autonomic nervous system.
Objective:
The purpose of this study was to test the hypothesis that impaired cardiac autonomic function might be associated with an enhanced stroke risk in AF patients.
Methods:
A total of 1922 AF patients who were in either sinus rhythm (SR group; n = 1121) or AF (AF group; n = 801) on a 5-minute resting electrocardiographic (ECG) recording were enrolled in the study. Heart rate variability triangular index (HRVI), standard deviation of normal-to-normal intervals, root mean square root of successive differences of normal-to-normal intervals, mean heart rate, 5-minute total power, and power in the high-frequency, low-frequency, and very-low-frequency ranges were calculated. Cox regression models were constructed to examine the association of heart rate variability (HRV) parameters with the composite endpoint of stroke or systemic embolism.
Results:
Mean age was 71 ± 8 years in the SR group and 75 ± 8 years in the AF group. Thirty-seven patients in the SR group (3.4%) and 60 patients in the AF group (8.0%) experienced a stroke or systemic embolism during follow-up of 5 years. In patients with SR, HRVI <15 was the strongest HRV parameter to be associated with stroke or systemic embolism (hazard ratio 3.04; 95% confidence interval 1.3-7.0; P = .009) after adjustment for multiple confounders. In the AF group, no HRV parameter was found to be associated with the composite endpoint.
Conclusion:
HRVI measured during SR on a single 5-minute ECG recording is independently associated with stroke or systemic embolism in AF patients. HRV analysis in SR may help to improve risk stratification in AF patients.
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