TY - JOUR
T1 - Chronotropic Incompetence and Risk of Atrial Fibrillation
T2 - The Henry Ford ExercIse Testing (FIT) Project
AU - O'Neal, Wesley T.
AU - Qureshi, Waqas T.
AU - Blaha, Michael J.
AU - Dardari, Zeina A.
AU - Ehrman, Jonathan K.
AU - Brawner, Clinton A.
AU - Soliman, Elsayed Z.
AU - Al-Mallah, Mouaz H.
N1 - Funding Information:
Dr. Qureshi is funded by Ruth L. Kirschstein NRSA Institutional Training Grant 5T32HL076132-10. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2016 American College of Cardiology Foundation
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Objectives The goal of this study was examine the association between chronotropic incompetence and incident atrial fibrillation (AF). Background Patients with an inadequate heart rate response during exercise may have abnormalities in sinus node function or autonomic tone that predispose to the development of AF. Methods The association between heart rate response and incident AF was examined in 57,402 patients (mean age 54 ± 13 years, 47% female, 64% white) free of baseline AF who underwent exercise treadmill stress testing from the Henry Ford ExercIse Testing (FIT) Project. Age-predicted maximum heart rate (pMHR) values <85% and chronotropic index values <80% were used to define chronotropic incompetence. Cox regression, adjusting for demographic characteristics, cardiovascular risk factors, medications, coronary heart disease, heart failure, and metabolic equivalent of task achieved, was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between chronotropic incompetence and incident AF. Results Over a median follow-up of 5.0 years (25th to 75th percentiles: 2.6 to 7.8 years), a total of 3,395 (5.9%) participants developed AF. pMHR values <85% were associated with an increased risk of developing AF (HR: 1.33; 95% CI: 1.22 to 1.44). Chronotropic index values <80% also were associated with an increased risk of AF (HR: 1.28; 95% CI: 1.19 to 1.38). Using varying cutoff points to define chronotropic incompetence, the associations of pMHR and chronotropic index with AF remained significant. Conclusions Our analysis suggests that patients with inadequate heart rate response during exercise have an increased risk of developing AF.
AB - Objectives The goal of this study was examine the association between chronotropic incompetence and incident atrial fibrillation (AF). Background Patients with an inadequate heart rate response during exercise may have abnormalities in sinus node function or autonomic tone that predispose to the development of AF. Methods The association between heart rate response and incident AF was examined in 57,402 patients (mean age 54 ± 13 years, 47% female, 64% white) free of baseline AF who underwent exercise treadmill stress testing from the Henry Ford ExercIse Testing (FIT) Project. Age-predicted maximum heart rate (pMHR) values <85% and chronotropic index values <80% were used to define chronotropic incompetence. Cox regression, adjusting for demographic characteristics, cardiovascular risk factors, medications, coronary heart disease, heart failure, and metabolic equivalent of task achieved, was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between chronotropic incompetence and incident AF. Results Over a median follow-up of 5.0 years (25th to 75th percentiles: 2.6 to 7.8 years), a total of 3,395 (5.9%) participants developed AF. pMHR values <85% were associated with an increased risk of developing AF (HR: 1.33; 95% CI: 1.22 to 1.44). Chronotropic index values <80% also were associated with an increased risk of AF (HR: 1.28; 95% CI: 1.19 to 1.38). Using varying cutoff points to define chronotropic incompetence, the associations of pMHR and chronotropic index with AF remained significant. Conclusions Our analysis suggests that patients with inadequate heart rate response during exercise have an increased risk of developing AF.
KW - atrial fibrillation
KW - chronotropic incompetence
KW - risk factors
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U2 - 10.1016/j.jacep.2016.03.013
DO - 10.1016/j.jacep.2016.03.013
M3 - Article
AN - SCOPUS:84996773721
SN - 2405-500X
VL - 2
SP - 645
EP - 652
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 6
ER -