Diurnal circadian variations in paroxysmal atrial fibrillation: The atherosclerosis risk in communities (ARIC) study

Jonathan Kim, Wendy Wang, Faye L. Norby, Michael Zhang, Alvaro Alonso, Pamela L. Lutsey, Elsayed Z. Soliman, Julian Wolfson, Lin Y. Chen

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Paroxysmal atrial fibrillation (AF) is challenging to diagnose due to its intermittent nature. Circadian rhythmicity has been reported for cardiovascular events such as myocardial infarction; whether diurnal variation exists for paroxysmal AF is less known. We characterized the temporal pattern of AF initiation in the Atherosclerosis Risk in Communities (ARIC) study, a prospective community-based cohort study. Methods: We included 74 ARIC study participants with paroxysmal AF detected by the Zio XT Patch at ARIC Visit 6 in 2016–17. We divided each participant's 2-week continuous monitoring data into 3-h intervals and summed the number of AF episodes in each interval. We performed Poisson regression using generalized estimating equations to estimate the effect of time of day on the number of AF episodes. Results: Compared to the reference interval of time 00:00–02:59, the time intervals 12:00–14:59, 15:00–17:59, and 18:00–20:59 had significantly higher frequency of AF initiation. Rate ratios (95% CI) for mean number of episodes in these three intervals were 1.91 (1.11, 2.92), 2.54 (1.42, 4.53), and 1.99 (1.19, 3.25) respectively. Furthermore, we found no significant association between duration of episode and time of day. Conclusion: There is diurnal variation in the initiation of AF episodes, with a peak in frequency in the late afternoon. Our finding is consistent with sympathetically driven AF. Pulse palpation or obtaining an electrocardiogram in the late afternoon may produce the highest diagnostic yield for AF.

Original languageEnglish (US)
Pages (from-to)98-103
Number of pages6
JournalJournal of Electrocardiology
StatePublished - Nov 11 2020

Bibliographical note

Funding Information:
The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health , Department of Health and Human Services, under Contract nos. ( HHSN268201700001I , HHSN268201700002I , HHSN268201700003I , HHSN268201700005I , HHSN268201700004I ). The authors thank the staff and participants of the ARIC study for their important contributions. This work was also supported by grants from the National Heart Lung and Blood Institute [ R01HL126637-01A1 (LYC), R01HL141288 (LYC), K24HL148521 (AA)] and the American Heart Association [ 16EIA26410001 (AA)].

Publisher Copyright:
© 2020 Elsevier Inc.


  • Arrhythmia
  • Atrial fibrillation
  • Electrocardiography
  • Heart rhythm disorder


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