title: Poor Heart Rate Recovery Is Associated With the Development of New-Onset Atrial Fibrillation in Middle-Aged Adults.
abstract: To investigate the association between heart rate recovery (HRR) and new-onset atrial fibrillation (AF) in middle-aged adults.
  
  
  
  Heart rate recovery was calculated using the exercise stress test in 15,729 apparently healthy self-referred men and women who attended periodic health screening examinations between January 2000, and December 2015. All participants completed the maximal exercise stress test according to the Bruce protocol and were followed clinically on a yearly basis for a median of 6.4±4 years. The primary end point was new-onset AF. Participants were grouped according to HRR at 5 minutes, dichotomized at the median value (<73 beats/min).
  
  
  
  Participants with low HRR were older, were more commonly men, had a higher rate of comorbidities, and were less fit. Kaplan-Meier survival analysis revealed that the cumulative probability of AF at 6 years was higher in participants with low HRR (2.1%) than in those with high HRR (0.6%) (log-rank, P<.001). Older age, male sex, obesity resting heart rate, and ischemic heart disease were all associated with increased AF risk in a univariate Cox regression model (P<.05 for all). Multivariate Cox regression analysis revealed that low HRR was independently associated with increased AF risk (hazard ratio, 1.92; 95% CI, 1.3-2.8; P<.001) after adjustment for multiple confounders.
  
  
  
  Lower HRR is independently associated with the development of new-onset AF during long-term follow-up in middle-aged adults.
authors.affiliation: Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Sabbag
authors.affiliation: Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Berkovitch
authors.affiliation: Departments of Internal Medicine A and C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yechezkel
authors.initials: Y
authors.lastname: Sidi
authors.affiliation: Departments of Internal Medicine A and C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shaye
authors.initials: S
authors.lastname: Kivity
authors.affiliation: Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Sagit
authors.initials: S
authors.lastname: Ben Zekry
authors.affiliation: Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Roy
authors.initials: R
authors.lastname: Beinart
authors.affiliation: Institute for Medical Screening, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Segev
authors.affiliation: Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Glikson
authors.affiliation: Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Pinchas Borenstein Talpiot Medical Leadership Program, The Chaim Sheba Medical Center, Tel Hashomer, Israel. Electronic address: eladmaor@gmail.com.
authors.forename: Elad
authors.initials: E
authors.lastname: Maor
mesh_terms: D000367:Age Factors; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology*