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  Attenuation of the heartbeat-evoked potential in patients with atrial fibrillation

Kumral, D., Al, E., Cesnaite, E., Kornej, J., Sander, C., Hensch, T., et al. (2022). Attenuation of the heartbeat-evoked potential in patients with atrial fibrillation. JACC: Clinical Electrophysiology, 8(10), 1219-1230. doi:10.1016/j.jacep.2022.06.019.

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 Creators:
Kumral, Deniz1, 2, 3, Author                 
Al, Esra1, 4, 5, Author                 
Cesnaite, Elena1, Author                 
Kornej, Jelena6, 7, Author
Sander, Christian7, 8, Author
Hensch, Tilman7, 8, 9, Author
Zeynalova, Samira7, Author
Tautenhahn, Sandra10, Author
Hagendorf, Andreas10, Author
Laufs, Ulrich10, Author
Wachter, Rolf10, Author
Nikulin, Vadim V.1, 11, Author                 
Villringer, Arno1, 4, 5, 7, Author                 
Affiliations:
1Department Neurology, MPI for Human Cognitive and Brain Sciences, Max Planck Society, ou_634549              
2Department of Psychology, Albert Ludwigs University Freiburg, Germany, ou_persistent22              
3Department of Clinical Psychology and Psychotherapy, Albert Ludwigs University Freiburg, Germany, ou_persistent22              
4MindBrainBody Institute, Berlin School of Mind and Brain, Humboldt University Berlin, Germany, ou_persistent22              
5Center for Stroke Research, Charité University Medicine Berlin, Germany, ou_persistent22              
6Cardiovascular Center, Boston University School of Medicine, MA, USA, ou_persistent22              
7Leipzig Research Center for Civilization Diseases (LIFE), University of Leipzig, Germany, ou_persistent22              
8Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Germany, ou_persistent22              
9Department of Psychology, University of Erfurt, Germany, ou_persistent22              
10Clinic and Policlinic for Cardiology, University Hospital Leipzig, Germany, ou_persistent22              
11Berlin Center for Advanced Neuroimaging (BCAN), Charité University Medicine Berlin, Germany, ou_persistent22              

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Free keywords: Atrial fibrillation; Echocardiography; Electrocardiogram; Electrocardiography; Electroencephalography; Heartbeat-evoked potential; Heart-brain connection
 Abstract: Background





The heartbeat-evoked potential (HEP) is a brain response to each heartbeat, which is thought to reflect cardiac signaling to central autonomic areas and suggested to be a marker of internal body awareness (e.g., interoception).


Objectives





Because cardiac communication with central autonomic circuits has been shown to be impaired in patients with atrial fibrillation (AF), we hypothesized that HEPs are attenuated in these patients.


Methods





By simultaneous electroencephalography and electrocardiography recordings, HEP was investigated in 56 individuals with persistent AF and 56 control subjects matched for age, sex, and body mass index.


Results





HEP in control subjects was characterized by right frontotemporal negativity peaking around 300 to 550 ms after the R-peak, consistent with previous studies. In comparison with control subjects, HEP amplitudes were attenuated, and HEP amplitude differences remained significant when matching the samples for heart frequency, stroke volume (assessed by echocardiography), systolic blood pressure, and the amplitude of the T-wave. Effect sizes for the group differences were medium to large (Cohen’s d between 0.6 and 0.9). EEG source analysis on HEP amplitude differences pointed to a neural representation within the right insular cortex, an area known as a hub for central autonomic control.


Conclusions





The heartbeat-evoked potential is reduced in AF, particularly in the right insula. We speculate that the attenuated HEP in AF may be a marker of impaired heart–brain interactions. Attenuated interoception might furthermore underlie the frequent occurrence of silent AF.

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Language(s): eng - English
 Dates: 2022-06-282022-04-062022-06-282022-08-31
 Publication Status: Published online
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: -
 Identifiers: DOI: 10.1016/j.jacep.2022.06.019
Other: epub 2022
PMID: 36265997
 Degree: -

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Title: JACC: Clinical Electrophysiology
Source Genre: Journal
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Publ. Info: Amsterdam : Elsevier
Pages: - Volume / Issue: 8 (10) Sequence Number: - Start / End Page: 1219 - 1230 Identifier: ISSN: 2405-5018
CoNE: https://pure.mpg.de/cone/journals/resource/2405-5018