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 (eg, 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.

中文翻译：

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房颤患者心跳诱发电位的衰减

背景

心跳诱发电位 (HEP) 是大脑对每次心跳的反应，它被认为反映了心脏向中央自主区域发出的信号，并被认为是身体内部意识（例如，内感受）的标志。

目标

由于心房颤动 (AF) 患者与中央自主回路的心脏通讯受损，我们假设这些患者的 HEP 减弱。

方法

通过同步脑电图和心电图记录，对 56 名持续性房颤患者和 56 名年龄、性别和体重指数相匹配的对照受试者进行了 HEP 调查。

结果

对照受试者的 HEP 的特征是右侧额颞叶负性在 R 峰后约 300 至 550 毫秒达到峰值，这与之前的研究一致。与对照受试者相比，HEP 振幅减弱，并且在匹配心率、每搏输出量（通过超声心动图评估）、收缩压和 T 波振幅的样本时，HEP 振幅差异仍然显着。组差异的影响大小为中到大（Cohen's d在 0.6 和 0.9 之间）。对 HEP 振幅差异的脑电图源分析指向右侧岛叶皮层内的神经表征，该区域被称为中央自主控制的枢纽。

结论

心跳诱发电位在 AF 中降低，尤其是在右侧脑岛。我们推测 AF 中减弱的 HEP 可能是心脑相互作用受损的标志。此外，减弱的内感受可能是无症状 AF 频繁发生的基础。