ArticleInternational journal of cardiology. Cardiovascular risk and prevention2023
Lower heart rates and beta-blockers are associated with new-onset atrial fibrillation.
Article in International journal of cardiology. Cardiovascular risk and prevention, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Cilostazol in patients with heart failure and preserved ejection fraction-The CLIP-HFpEF trial.ESC heart failure · 2025Trial
- Effects of Continuous Accelerated Pacing on Cardiac Structure and Function in Patients With Heart Failure With Preserved Ejection Fraction: Insights From the myPACE Randomized Clinical Trial.Journal of the American Heart Association · 2024Trial
- Real-World Treatment of Patients With Sinus Node Dysfunction and Heart Failure With Preserved Ejection Fraction.Pacing and clinical electrophysiology : PACE · 2026Article
- Comprehensive Conduction System Pacing as Antiarrhythmic Strategy in Atrial Fibrillation.JACC. Case reports · 2025Article
- Value of routine heart rate variability parameters for atrial fibrillation detection in ischaemic stroke and high-risk TIA patients.Frontiers in stroke · 2025Article
- Aging diastole - root cause for atrial fibrillation and heart failure with preserved ejection fraction.The journal of cardiovascular aging · 2024Article
- Accelerated physiologic pacing in patients with heart failure with preserved ejection fraction: An argument in support of therapeutic heart rate modulation.Heart rhythm O2 · 2024Article
- Rationale and design of the PACE HFpEF trial: Physiologic accelerated pacing as a holistic treatment of heart failure with preserved ejection fraction.Heart rhythm O2 · 2024Article
- Personalized accelerated physiologic pacing.European heart journal supplements : journal of the European Society of Cardiology · 2023Article
- Association of Nondihydropyridine Calcium Channel Blockers Versus β-Adrenergic Receptor Blockers With Risk of Heart Failure Hospitalization.The American journal of cardiology · 2023Article
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Authors and funding
7 authors.
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Abstract
Background: Lower heart rates (HRs) prolong diastole, which increases filling pressures and wall stress. As a result, lower HRs may be associated with higher brain natriuretic peptide (BNP) levels and incident atrial fibrillation (AF). Beta-blockers may increase the risk for AF due to suppression of resting HRs. Objective: Examine the relationships of HR, BNP, beta-blockers and new-onset AF in the REVEAL-AF and SPRINT cohort of subjects at risk for developing AF. Methods: In REVEAL-AF, 383 subjects without a history of AF and a mean CHA Results: The median daytime HR in the REVEAL-AF cohort was 75bpm [IQR 68-83]. Subjects with below-median HRs had 2.4-fold higher BNP levels compared to subjects with above-median HRs (median BNP [IQR]: 62 pg/dl [37-112] vs. 26 pg/dl [13-53], p < 0.001). HRs <75bpm were associated with a higher incidence of AF: 37% vs. 27%, p < 0.05. This was validated in the SPRINT cohort after adjusting for AF risk factors. Both a HR < 75bpm and beta-blocker use were associated with a higher rate of AF: 1.9 vs 0.7% (p < 0.001) and 2.5% vs. 0.6% (p < 0.001), respectively. The hazard ratio for patients on beta-blockers to develop AF was 3.72 [CI 2.32, 5.96], p < 0.001. Conclusions: Lower HRs are associated with higher BNP levels and incident AF, mimicking the hemodynamic effects of diastolic dysfunction. Suppression of resting HR by beta-blockers could explain their association with incident AF.
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