title: Autonomic dysfunction is associated with brief episodes of atrial fibrillation in type 2 diabetes.
abstract: OBJECTIVE
  This study aimed to investigate the relationship between asymptomatic episodes of atrial fibrillation (AF) and abnormalities of the autonomic nervous system in type 2 diabetic patients who did not have evidence of atrial fibrillation at baseline.
  
  
  RESULTS
  In a multicentric cross-sectional controlled study, 1992 patients with type 2 diabetes were screened. All underwent ambulatory ECG recording for 48-hour at 3, 6, 9, and 12months. Heart rate variability (HRV) was used as indicator of autonomic activity. One hundred seventy-six diabetics with silent atrial fibrillation episodes (SAFE group) and 288 without silent atrial fibrillation (non-SAFE group) were enrolled. These selected diabetics were matched on clinical and anthropometric data to 120 control subjects without diabetes of the control group. HRV analysis evidenced that LF/HF ratio was significantly higher in the SAFE group than in the non-SAFE group (P<0.05) in the whole period of HM analysis. AF absolute burdens were positively correlated with LF/HF ratio (r=0.31, P<0.001). Multiple regression analysis showed that LF/HF ratio was an independent determinant of AF episodes.
  
  
  CONCLUSIONS
  This study originally showed a strong relationship between autonomic dysfunction and silent atrial fibrillation in type 2 diabetes.
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Italy.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Rizzo
authors.affiliation: Department of Internal and Experimental Medicine Center of Cardiovascular Excellence Second University of Naples, Italy.
authors.forename: Ferdinando Carlo
authors.initials: FC
authors.lastname: Sasso
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Italy. Electronic address: raffaele.marfella@unina2.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Marfella
authors.affiliation: Department of Cardiology, Hospital Cardarelli, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Siniscalchi
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Paolisso
authors.affiliation: Department of Internal and Experimental Medicine Center of Cardiovascular Excellence Second University of Naples, Italy.
authors.forename: Ornella
authors.initials: O
authors.lastname: Carbonara
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Italy.
authors.forename: Maria Carmela
authors.initials: MC
authors.lastname: Capoluongo
authors.affiliation: University of Birmingham, Institute of Biomedical Research, Second University of Naples, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Lascar
authors.affiliation: Department of Anaesthesiology Sciences, Second University of Naples, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Pace
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Italy.
authors.forename: Celestino
authors.initials: C
authors.lastname: Sardu
authors.affiliation: Department of Anaesthesiology Sciences, Second University of Naples, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Passavanti
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Italy.
authors.forename: Michelangela
authors.initials: M
authors.lastname: Barbieri
authors.affiliation: Department of Internal and Experimental Medicine Center of Cardiovascular Excellence Second University of Naples, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Mauro
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Paolisso
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology*; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Atrial fibrillation; Autonomic nervous system; ECG Holter; Heart rate variability; Type 2 diabetes