Circadian variation of variability and irregularity of heart rate in patients with permanent atrial fibrillation: Relation to symptoms and rate-control drugs.

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Circadian variation of variability and irregularity of heart rate in patients with permanent atrial fibrillation: Relation to symptoms and rate-control drugs. / Corino, Valentina D A; Platonov, Pyotr; Enger, Steve; Tveit, Arnljot; Ulimoen, Sara R.

I: American Journal of Physiology: Heart and Circulatory Physiology, Vol. 309, Nr. 12, 2015, s. H2152-H2157.

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskrift

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T1 - Circadian variation of variability and irregularity of heart rate in patients with permanent atrial fibrillation: Relation to symptoms and rate-control drugs.

AU - Corino, Valentina D A

AU - Platonov, Pyotr

AU - Enger, Steve

AU - Tveit, Arnljot

AU - Ulimoen, Sara R

PY - 2015

Y1 - 2015

N2 - The aim of this study is to evaluate the diurnal variation of the variability and irregularity of the heart rate (HR) in patients with permanent atrial fibrillation (AF), with and without rate-control drugs. Thirty-eight patients with permanent AF were part of an investigator-blind cross-over study, comparing diltiazem, verapamil, metoprolol, and carvedilol. We analyzed five Holter recordings per patient: at baseline (no rate-control drug) and with each of the four drug regimens. HR, variability (standard deviation, pNN20, pNN50, pNN80, and rMSSD) and irregularity (approximate (APEn) and sample entropy) parameters were computed in 20-minute long non-overlapping segments. Circadian rhythmicity was evaluated using the cosinor analysis to each parameter series, that is characterized by the 24-h mean (MESOR) and the excursion over the mean (the amplitude). Arrhythmia-related symptoms were assessed by a questionnaire measuring symptoms severity (SS) and frequency (SF). HR and variability parameters showed a significant circadian variation in most patients, whereas only a small minority of the patients had circadian variation of irregularity parameters. The patients with circadian ApEn at baseline had more severe symptoms (SS = 9±4 vs. 6±5, p<0.05; circadian vs. non-circadian variation). All drugs decreased the MESOR of HR and increased the MESOR of variability parameters. Only carvedilol and metoprolol decreased the normalized amplitude over the 24-h of all parameters and HR. In conclusion, HR and RR variability parameters present a circadian variation in patients with permanent AF, whereas few patients demonstrated circadian fluctuations in irregularity parameters, suggesting different physiological mechanisms.

AB - The aim of this study is to evaluate the diurnal variation of the variability and irregularity of the heart rate (HR) in patients with permanent atrial fibrillation (AF), with and without rate-control drugs. Thirty-eight patients with permanent AF were part of an investigator-blind cross-over study, comparing diltiazem, verapamil, metoprolol, and carvedilol. We analyzed five Holter recordings per patient: at baseline (no rate-control drug) and with each of the four drug regimens. HR, variability (standard deviation, pNN20, pNN50, pNN80, and rMSSD) and irregularity (approximate (APEn) and sample entropy) parameters were computed in 20-minute long non-overlapping segments. Circadian rhythmicity was evaluated using the cosinor analysis to each parameter series, that is characterized by the 24-h mean (MESOR) and the excursion over the mean (the amplitude). Arrhythmia-related symptoms were assessed by a questionnaire measuring symptoms severity (SS) and frequency (SF). HR and variability parameters showed a significant circadian variation in most patients, whereas only a small minority of the patients had circadian variation of irregularity parameters. The patients with circadian ApEn at baseline had more severe symptoms (SS = 9±4 vs. 6±5, p<0.05; circadian vs. non-circadian variation). All drugs decreased the MESOR of HR and increased the MESOR of variability parameters. Only carvedilol and metoprolol decreased the normalized amplitude over the 24-h of all parameters and HR. In conclusion, HR and RR variability parameters present a circadian variation in patients with permanent AF, whereas few patients demonstrated circadian fluctuations in irregularity parameters, suggesting different physiological mechanisms.

U2 - 10.1152/ajpheart.00300.2015

DO - 10.1152/ajpheart.00300.2015

M3 - Article

VL - 309

SP - H2152-H2157

JO - American Journal of Physiology - Heart and Circulatory Physiology

T2 - American Journal of Physiology - Heart and Circulatory Physiology

JF - American Journal of Physiology - Heart and Circulatory Physiology

SN - 1522-1539

IS - 12

ER -