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Heart rate and premature atrial contractions at 24hECG independently predict atrial fibrillation in a population-based study

Persson, Anders Paul LU ; Fedorowski, Artur LU ; Hedblad, Bo LU ; Persson, Margaretha LU ; Juul-Möller, Steen LU ; Engström, Gunnar LU and Johnson, Linda S B LU (2019) In British Heart Journal p.1-5
Abstract

BACKGROUND: Low resting heart rate and premature atrial contractions (PACs) predict incident atrial fibrillation (AF) and could be interdependent, since PACs occur in the gaps between normal beats.

OBJECTIVE: To study the association between low heart rate at 24hECG, PACs and incident AF in a prospective population-based cohort.

METHODS: In the Malmö Diet and Cancer study, 24hECGs were performed in 377 AF-free subjects. The endpoint was clinical AF retrieved from national hospital (mean follow-up 17 years). The interaction between increased supraventricular activity (SVA) top quartile of either PACs/hour or supraventricular tachycardias/hour) and mean heart rate (mHR) as regards AF risk was assessed in multivariable Cox... (More)

BACKGROUND: Low resting heart rate and premature atrial contractions (PACs) predict incident atrial fibrillation (AF) and could be interdependent, since PACs occur in the gaps between normal beats.

OBJECTIVE: To study the association between low heart rate at 24hECG, PACs and incident AF in a prospective population-based cohort.

METHODS: In the Malmö Diet and Cancer study, 24hECGs were performed in 377 AF-free subjects. The endpoint was clinical AF retrieved from national hospital (mean follow-up 17 years). The interaction between increased supraventricular activity (SVA) top quartile of either PACs/hour or supraventricular tachycardias/hour) and mean heart rate (mHR) as regards AF risk was assessed in multivariable Cox regression analyses adjusted for age, sex, height, BMI, systolic blood pressure, antihypertensive medication, smoking and homeostasis model assessment of insulin resistance.

RESULTS: There were 80 (21%) incident cases of AF. Below median mHR (80 bpm/75 bpm for women/men) was associated with increased AF incidence (HR: 1.89, 95% CI 1.18 to 3.02, p=0.008). There was no correlation between mHR and SVA (p=0.6) or evidence of a multiplicative interaction between these factors for AF risk (p for interaction=0.6) In the group with both increased SVA and below median mHR (17% of the population) the relative risk of AF was very high (HR 4.5, 95% CI 2.2 to 9.1, p=0.001).

CONCLUSION: Low mHR at 24hECG independently predicts AF, but there is no association between mHR and SVA, and these factors are independent as regards AF risk. Subjects with both low mHR and increased SVA have high AF risk.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
British Heart Journal
pages
1 - 5
publisher
BMJ Publishing Group
ISSN
1355-6037
DOI
10.1136/heartjnl-2019-315119
language
English
LU publication?
yes
id
139d838c-1c05-485d-bce0-1cb922e5a183
date added to LUP
2019-08-22 07:44:01
date last changed
2019-08-27 02:20:49
@article{139d838c-1c05-485d-bce0-1cb922e5a183,
  abstract     = {<p>BACKGROUND: Low resting heart rate and premature atrial contractions (PACs) predict incident atrial fibrillation (AF) and could be interdependent, since PACs occur in the gaps between normal beats.</p><p>OBJECTIVE: To study the association between low heart rate at 24hECG, PACs and incident AF in a prospective population-based cohort.</p><p>METHODS: In the Malmö Diet and Cancer study, 24hECGs were performed in 377 AF-free subjects. The endpoint was clinical AF retrieved from national hospital (mean follow-up 17 years). The interaction between increased supraventricular activity (SVA) top quartile of either PACs/hour or supraventricular tachycardias/hour) and mean heart rate (mHR) as regards AF risk was assessed in multivariable Cox regression analyses adjusted for age, sex, height, BMI, systolic blood pressure, antihypertensive medication, smoking and homeostasis model assessment of insulin resistance.</p><p>RESULTS: There were 80 (21%) incident cases of AF. Below median mHR (80 bpm/75 bpm for women/men) was associated with increased AF incidence (HR: 1.89, 95% CI 1.18 to 3.02, p=0.008). There was no correlation between mHR and SVA (p=0.6) or evidence of a multiplicative interaction between these factors for AF risk (p for interaction=0.6) In the group with both increased SVA and below median mHR (17% of the population) the relative risk of AF was very high (HR 4.5, 95% CI 2.2 to 9.1, p=0.001).</p><p>CONCLUSION: Low mHR at 24hECG independently predicts AF, but there is no association between mHR and SVA, and these factors are independent as regards AF risk. Subjects with both low mHR and increased SVA have high AF risk.</p>},
  author       = {Persson, Anders Paul and Fedorowski, Artur and Hedblad, Bo and Persson, Margaretha and Juul-Möller, Steen and Engström, Gunnar and Johnson, Linda S B},
  issn         = {1355-6037},
  language     = {eng},
  month        = {08},
  pages        = {1--5},
  publisher    = {BMJ Publishing Group},
  series       = {British Heart Journal},
  title        = {Heart rate and premature atrial contractions at 24hECG independently predict atrial fibrillation in a population-based study},
  url          = {http://dx.doi.org/10.1136/heartjnl-2019-315119},
  year         = {2019},
}