Nonlinear Heart Rate Dynamics Before and After Paroxysmal Atrial Fibrillation Events

Ting-Wei Ernie Liao; Li-Wei Lo; Yenn-Jiang Lin; Shih-Lin Chang; Yu-Feng Hu; Fa-Po Chung; Tze-Fan Chao; Jo-Nan Liao; Hui-Wen Yang; Men-Tzung Lo; Shih-Ann Chen

doi:10.6515/ACS.202209_38(5).20220328A

Nonlinear Heart Rate Dynamics Before and After Paroxysmal Atrial Fibrillation Events

Acta Cardiol Sin. 2022 Sep;38(5):594-600. doi: 10.6515/ACS.202209_38(5).20220328A.

Authors

Ting-Wei Ernie Liao^{1

2

3}, Li-Wei Lo^{1

2

3}, Yenn-Jiang Lin^{1

2

3}, Shih-Lin Chang^{1

2

3}, Yu-Feng Hu^{1

2

3}, Fa-Po Chung^{1

2

3}, Tze-Fan Chao^{1

2

3}, Jo-Nan Liao^{1

2

3}, Hui-Wen Yang^{4

5}, Men-Tzung Lo⁴, Shih-Ann Chen^{1

2

3

6}

Affiliations

¹ School of Medicine, College of Medicine, National Yang Ming Chiao Tung University.
² Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.
³ Institute of Clinical Medicine, Cardiovascular Research Institute, National Yang Ming Chiao Tung University, Taipei.
⁴ Institute of Translational and Interdisciplinary Medicine and Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan.
⁵ Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, United States.
⁶ Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.

Abstract

Background: Heart rate complexity, derived from nonlinear heart rate variability (HRV), has been shown to help predict the outcomes of various diseases. Changes in heart rate complexity before and after paroxysmal atrial fibrillation (PAF) events are unclear.

Objectives: To evaluate changes in heart rate complexity through nonlinear HRV before and after PAF events.

Methods: We enrolled 65 patients (72 ± 12.34 years old, 31 females) with 99 PAF events who received 24-hour Holter recording, and analyzed nonlinear HRV variables including Poincaré plot analysis, sample entropy (SampEn), and multiscale entropy (MSE). HRV analyses were applied to a 20-minute window before the onset and after the termination of PAF events. HRV parameters were evaluated and compared based on eight different 5-minute time segments, as we divided each 20-minute window into four segments of 5 minutes each.

Results: SampEn and MSE_1~5 significantly decreased before the onset of PAF events, whereas SampEn, MSE_1~5 and MSE_6~20 significantly increased after the termination of PAF events. SD1 and SD2, which are nonlinear HRV parameters calculated via Poincaré plot analysis, did not significantly change before the PAF events, however they both decreased significantly after termination.

Conclusions: Heart rate complexity significantly decreased before the initiation and increased after the termination of PAF events, which indicates the crucial role of nonlinear heart rate dynamics in the initiation and termination of PAF.

Keywords: Atrial fibrillation; Heart rate complexity; Heart rate variability; Multiscale entropy; Nonlinear heart rate variability; Poincaré plot analysis.