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Involvement of Autonomic Nervous System in New-Onset Atrial Fibrillation during Acute Myocardial Infarction

Background: Atrial fibrillation (AF) is common after acute myocardial infarction (AMI) and associated with in-hospital and long-term mortality. However, the pathophysiology of AF in AMI is poorly understood. Heart rate variability (HRV), measured by Holter-ECG, reflects cardiovascular response to th...

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Autores principales: Sagnard, Audrey, Guenancia, Charles, Mouhat, Basile, Maza, Maud, Fichot, Marie, Moreau, Daniel, Garnier, Fabien, Lorgis, Luc, Cottin, Yves, Zeller, Marianne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290762/
https://www.ncbi.nlm.nih.gov/pubmed/32423138
http://dx.doi.org/10.3390/jcm9051481
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author Sagnard, Audrey
Guenancia, Charles
Mouhat, Basile
Maza, Maud
Fichot, Marie
Moreau, Daniel
Garnier, Fabien
Lorgis, Luc
Cottin, Yves
Zeller, Marianne
author_facet Sagnard, Audrey
Guenancia, Charles
Mouhat, Basile
Maza, Maud
Fichot, Marie
Moreau, Daniel
Garnier, Fabien
Lorgis, Luc
Cottin, Yves
Zeller, Marianne
author_sort Sagnard, Audrey
collection PubMed
description Background: Atrial fibrillation (AF) is common after acute myocardial infarction (AMI) and associated with in-hospital and long-term mortality. However, the pathophysiology of AF in AMI is poorly understood. Heart rate variability (HRV), measured by Holter-ECG, reflects cardiovascular response to the autonomic nervous system and altered (reduced or enhanced) HRV may have a major role in the onset of AF in AMI patients. Objective: We investigated the relationship between autonomic dysregulation and new-onset AF during AMI. Methods: As part of the RICO survey, all consecutive patients hospitalized for AMI at Dijon (France) university hospital between June 2001 and November 2014 were analyzed by Holter-ECG <24 h following admission. HRV was measured using temporal and spectral analysis. Results: Among the 2040 included patients, 168 (8.2%) developed AF during AMI. Compared to the sinus-rhythm (SR) group, AF patients were older, had more frequent hypertension and lower left ventricular ejection fraction LVEF. On the Holter parameters, AF patients had higher pNN50 values (11% vs. 4%, p < 0.001) and median LH/HF ratio, a reflection of sympathovagal balance, was significantly lower in the AF group (0.88 vs 2.75 p < 0.001). The optimal LF/HF cut-off for AF prediction was 1.735. In multivariate analyses, low LF/HF <1.735 (OR(95%CI) = 3.377 (2.047–5.572)) was strongly associated with AF, ahead of age (OR(95%CI) = 1.04(1.01–1.06)), mean sinus-rhythm rate (OR(95%CI) = 1.03(1.02–1.05)) and log NT-proBNP (OR(95%CI) = 1.38(1.01–1.90). Conclusion: Our study strongly suggests that new-onset AF in AMI mainly occurs in a dysregulated autonomic nervous system, as suggested by low LF/HF, and higher PNN50 and RMSSD values.
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spelling pubmed-72907622020-06-17 Involvement of Autonomic Nervous System in New-Onset Atrial Fibrillation during Acute Myocardial Infarction Sagnard, Audrey Guenancia, Charles Mouhat, Basile Maza, Maud Fichot, Marie Moreau, Daniel Garnier, Fabien Lorgis, Luc Cottin, Yves Zeller, Marianne J Clin Med Article Background: Atrial fibrillation (AF) is common after acute myocardial infarction (AMI) and associated with in-hospital and long-term mortality. However, the pathophysiology of AF in AMI is poorly understood. Heart rate variability (HRV), measured by Holter-ECG, reflects cardiovascular response to the autonomic nervous system and altered (reduced or enhanced) HRV may have a major role in the onset of AF in AMI patients. Objective: We investigated the relationship between autonomic dysregulation and new-onset AF during AMI. Methods: As part of the RICO survey, all consecutive patients hospitalized for AMI at Dijon (France) university hospital between June 2001 and November 2014 were analyzed by Holter-ECG <24 h following admission. HRV was measured using temporal and spectral analysis. Results: Among the 2040 included patients, 168 (8.2%) developed AF during AMI. Compared to the sinus-rhythm (SR) group, AF patients were older, had more frequent hypertension and lower left ventricular ejection fraction LVEF. On the Holter parameters, AF patients had higher pNN50 values (11% vs. 4%, p < 0.001) and median LH/HF ratio, a reflection of sympathovagal balance, was significantly lower in the AF group (0.88 vs 2.75 p < 0.001). The optimal LF/HF cut-off for AF prediction was 1.735. In multivariate analyses, low LF/HF <1.735 (OR(95%CI) = 3.377 (2.047–5.572)) was strongly associated with AF, ahead of age (OR(95%CI) = 1.04(1.01–1.06)), mean sinus-rhythm rate (OR(95%CI) = 1.03(1.02–1.05)) and log NT-proBNP (OR(95%CI) = 1.38(1.01–1.90). Conclusion: Our study strongly suggests that new-onset AF in AMI mainly occurs in a dysregulated autonomic nervous system, as suggested by low LF/HF, and higher PNN50 and RMSSD values. MDPI 2020-05-14 /pmc/articles/PMC7290762/ /pubmed/32423138 http://dx.doi.org/10.3390/jcm9051481 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sagnard, Audrey
Guenancia, Charles
Mouhat, Basile
Maza, Maud
Fichot, Marie
Moreau, Daniel
Garnier, Fabien
Lorgis, Luc
Cottin, Yves
Zeller, Marianne
Involvement of Autonomic Nervous System in New-Onset Atrial Fibrillation during Acute Myocardial Infarction
title Involvement of Autonomic Nervous System in New-Onset Atrial Fibrillation during Acute Myocardial Infarction
title_full Involvement of Autonomic Nervous System in New-Onset Atrial Fibrillation during Acute Myocardial Infarction
title_fullStr Involvement of Autonomic Nervous System in New-Onset Atrial Fibrillation during Acute Myocardial Infarction
title_full_unstemmed Involvement of Autonomic Nervous System in New-Onset Atrial Fibrillation during Acute Myocardial Infarction
title_short Involvement of Autonomic Nervous System in New-Onset Atrial Fibrillation during Acute Myocardial Infarction
title_sort involvement of autonomic nervous system in new-onset atrial fibrillation during acute myocardial infarction
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290762/
https://www.ncbi.nlm.nih.gov/pubmed/32423138
http://dx.doi.org/10.3390/jcm9051481
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