Evidence map›Paper›PMID 28104071›Full record

ArticleJournal of the American College of Cardiology2017

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

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American College of Cardiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 98 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
98citing papers in PubMed, 3 pooled it
9.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

98 citing papers in PubMed, 3 syntheses or guidelines pooled it, 157 citations in OpenAlex.

  1. Pooled it
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  4. Trial
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  6. Baroreflex Sensitivity in Patients With Atrial Fibrillation.Journal of the American Heart Association · 2020
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  10. Atrial cardiomyopathy as a multidomain disease: longitudinal evidence for autonomic remodelling.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
    Article
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  19. Article
  20. Autonomic dysregulation and atrial arrhythmias.American journal of physiology. Cell physiology · 2025
    Review

38 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 7 institutions in 1 country.

Sunil K AgarwalCardiovascular Institute, Mount Sinai School of Medicine, New York, New York; Division of General Internal Medicine and Epidemiology, Johns Hopkins University, Baltimore, Maryland. Electronic address: sunilagarwal1@gmail.com.
Faye L NorbyDepartment of Epidemiology and Cardiology, University of Minnesota, Minneapolis, Minnesota.
Eric A WhitselDepartment of Epidemiology and Medicine, University of North Carolina, Chapel Hill, North Carolina.
Elsayed Z SolimanDepartment of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Lin Y ChenCardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Laura R LoehrDepartment of Epidemiology and Medicine, University of North Carolina, Chapel Hill, North Carolina.
Valentin FusterCardiovascular Institute, Mount Sinai School of Medicine, New York, New York.
Gerardo HeissDepartment of Epidemiology and Medicine, University of North Carolina, Chapel Hill, North Carolina.
Josef CoreshDivision of General Internal Medicine and Epidemiology, Johns Hopkins University, Baltimore, Maryland.
Alvaro AlonsoDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
University of North Carolina at Chapel Hill · USJohns Hopkins University · USEmory University · USIcahn School of Medicine at Mount Sinai · USUniversity of Minnesota · USUniversity of Minnesota Medical Center · USWake Forest University · US

Funding

CARDIOVASCULAR EPIDEMIOLOGY INSTITUTIONAL TRAININGT32HL007024 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI Elizabeth Selvin · 1985 to 2026
$17.5M
Epidemiologic Study of Risk Factors and Biomarkers of Atrial FibrillationRC1HL099452 · NHLBI · UNIVERSITY OF MINNESOTA · PI ALONSO, ALVARO · 2009 to 2010
$897k
American Heart Association-American Stroke Association 16EIA26410001NHLBI NIH HHS HHSN268201100005CNHLBI NIH HHS HHSN268201100005GNHLBI NIH HHS HHSN268201100005INHLBI NIH HHS HHSN268201100006CNHLBI NIH HHS HHSN268201100007CNHLBI NIH HHS HHSN268201100007INHLBI NIH HHS HHSN268201100008CNHLBI NIH HHS HHSN268201100008INHLBI NIH HHS HHSN268201100009CNHLBI NIH HHS HHSN268201100009INHLBI NIH HHS HHSN268201100010CNHLBI NIH HHS HHSN268201100011CNHLBI NIH HHS HHSN268201100011INHLBI NIH HHS HHSN268201100012CNHLBI NIH HHS RC1 HL099452NHLBI NIH HHS T32 HL007024
6 · The paper itself

Abstract

backgroundCardiac 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.

objectivesThis study sought to study the association between HRV and risk of AF.

methodsThis 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.

resultsDuring 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).

conclusionsCardiac 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.

Indexed as

AdultAtrial FibrillationAutonomic Nervous System DiseasesElectrocardiographyFemaleFollow-Up StudiesHeart DiseasesHeart RateHumansMaleMiddle Agedarrhythmiafrequencyheart rate variabilityparasympatheticsympathetic

Identifiers

PMID28104071
PMCPMC5260487
OpenAlexW2572458371

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.