Cardiac Autonomic Dysfunction and Incidence of Atrial Fibrillation: Results From 20 Years Follow-Up

Sunil K. Agarwal, Faye L. Norby, Eric A. Whitsel, Elsayed Z. Soliman, Lin Y. Chen, Laura R. Loehr, Valentin Fuster, Gerardo Heiss, Josef Coresh, Alvaro Alonso

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48 Scopus citations


Background Cardiac autonomic perturbations frequently antecede onset of paroxysmal atrial fibrillation (AF). Interventions that influence autonomic inputs to myocardium may prevent AF. However, whether low heart rate or heart rate variability (HRV), which are noninvasive measures of cardiac autonomic dysfunction, are associated with AF incidence is unclear. Objectives This study sought to study the association between HRV and risk of AF. Methods This study included 11,715 middle-aged adults in the ARIC (Atherosclerosis Risk In Communities) cohort with heart rate and HRV measures obtained from 2-min electrocardiogram recordings performed at baseline (1987 to 1989). These measures included SD of normal-to-normal RR intervals, high-frequency (HF) (0.15 to 0.40 Hz), low-frequency (0.04 to 0.15 Hz), and the low-frequency/HF ratio (denoting a greater sympathetic to parasympathetic dominance). Incident AF cases were ascertained by electrocardiogram at ARIC follow-up visits, hospital discharge diagnosis, or death certificates through 2011. Results During an average follow-up of 19.4 years, 1,580 or 13.5% of participants developed AF. A baseline heart rate <60 beats/min was associated modestly with an increased risk of AF. Lower overall HRV as well as increased sympathetic/parasympathetic tone were associated independently with a higher risk of AF; the hazard ratio for each 1 SD lower SD of normal-to-normal RR intervals was 1.14 (95% confidence interval: 1.08 to 1.21), for HF was 1.12 (95% confidence interval: 1.06 to 1.17), and for low frequency/HF was 1.08 (95% confidence interval: 1.03 to 1.14). Conclusions Cardiac autonomic dysfunction denoted by low resting short-term HRV was associated with higher AF incidence. A low heart rate may be associated with higher AF risk. Further studies are needed to determine whether interventions in the general population to restore autonomic balance may prevent AF.

Original languageEnglish (US)
Pages (from-to)291-299
Number of pages9
JournalJournal of the American College of Cardiology
Issue number3
StatePublished - Jan 24 2017

Bibliographical note

Publisher Copyright:
© 2017 American College of Cardiology Foundation

Copyright 2017 Elsevier B.V., All rights reserved.


  • arrhythmia
  • frequency
  • heart rate variability
  • parasympathetic
  • sympathetic

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