Jean-Marie Grégoire, Cédric Gilon, François Marelli, Pascal Godart, Hugues Bersini, Stéphane Carlier
{"title":"Autonomic Nervous System Activity before Atrial Fibrillation Onset as Assessed by Heart Rate Variability.","authors":"Jean-Marie Grégoire, Cédric Gilon, François Marelli, Pascal Godart, Hugues Bersini, Stéphane Carlier","doi":"10.31083/RCM25364","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Neuromodulation has been shown to increase the efficacy of atrial fibrillation (AF) ablation procedures. However, despite its ability to influence the autonomic nervous system (ANS), the exact mechanism of action remains unclear. The activity of the ANS via the intracardiac nervous system (ICNS) can be inferred from heart rate variability (HRV). Therefore, this study aims to investigate the significance of changes in the ICNS prior to the onset of AF by analyzing the evolution of HRV in a large new cohort of patients.</p><p><strong>Methods: </strong>We selected and annotated recordings with AF and atrial flutter from our database of 95,871 Holter recordings. Each recording included both sinus rhythm and one or more AF episodes. We computed parameters estimating parasympathetic activity (root mean square of successive RR interval differences (RMSSD) and percentage of successive RR intervals that differ by more than 50 ms (pNN50)), as well as HRV frequential parameters a few minutes before AF onset. To allow a minute-by-minute assessment of the parameter changes, we computed their values over 5-minute sliding windows, starting at 35 minutes before AF onset.</p><p><strong>Results: </strong>The mean age of the whole group of patients was 71.1 ± 11.3 years (range 35-99), the total number of episodes was 1319 on 623 recordings from 570 patients, with an average of 2.1 ± 2.2 episodes per recording (range 1-17) and 2.3 ± 2.6 episodes per patient (range 1-21). The proportion of premature atrial contractions (PACs) increased from 4.8 ± 0.3%, 35 minutes before the onset of AF to 8.3 ± 0.4%, 5 minutes before the AF episode. We measured a statistically significant increase in very-low-frequency (VLF), low-frequency (LF), high-frequency (HF), RMSSD and pNN50 between 35 minutes and 5 minutes before AF onset.</p><p><strong>Conclusions: </strong>Our data suggest that a significant short-term increase in vagal activity precedes most AF events. Dynamic changes in HRV parameters could be considered when determining the optimal neuromodulation strategies.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"26 1","pages":"25364"},"PeriodicalIF":1.9000,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11760543/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Reviews in cardiovascular medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.31083/RCM25364","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Autonomic Nervous System Activity before Atrial Fibrillation Onset as Assessed by Heart Rate Variability.
Background: Neuromodulation has been shown to increase the efficacy of atrial fibrillation (AF) ablation procedures. However, despite its ability to influence the autonomic nervous system (ANS), the exact mechanism of action remains unclear. The activity of the ANS via the intracardiac nervous system (ICNS) can be inferred from heart rate variability (HRV). Therefore, this study aims to investigate the significance of changes in the ICNS prior to the onset of AF by analyzing the evolution of HRV in a large new cohort of patients.
Methods: We selected and annotated recordings with AF and atrial flutter from our database of 95,871 Holter recordings. Each recording included both sinus rhythm and one or more AF episodes. We computed parameters estimating parasympathetic activity (root mean square of successive RR interval differences (RMSSD) and percentage of successive RR intervals that differ by more than 50 ms (pNN50)), as well as HRV frequential parameters a few minutes before AF onset. To allow a minute-by-minute assessment of the parameter changes, we computed their values over 5-minute sliding windows, starting at 35 minutes before AF onset.
Results: The mean age of the whole group of patients was 71.1 ± 11.3 years (range 35-99), the total number of episodes was 1319 on 623 recordings from 570 patients, with an average of 2.1 ± 2.2 episodes per recording (range 1-17) and 2.3 ± 2.6 episodes per patient (range 1-21). The proportion of premature atrial contractions (PACs) increased from 4.8 ± 0.3%, 35 minutes before the onset of AF to 8.3 ± 0.4%, 5 minutes before the AF episode. We measured a statistically significant increase in very-low-frequency (VLF), low-frequency (LF), high-frequency (HF), RMSSD and pNN50 between 35 minutes and 5 minutes before AF onset.
Conclusions: Our data suggest that a significant short-term increase in vagal activity precedes most AF events. Dynamic changes in HRV parameters could be considered when determining the optimal neuromodulation strategies.
期刊介绍：
RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
