Is the Median Hourly Ambulatory Heart Rate Range Helpful in Stratifying Mortality Risk among Newly Diagnosed Atrial Fibrillation Patients?

Hsing-Yu Chen,John Malik,Hau-Tieng Wu,Chun-Li Wang

doi:10.3390/jpm11111202

Abstract

Background: The application of heart rate variability is problematic in patients with atrial fibrillation (AF). This study aims to explore the associations between all-cause mortality and the median hourly ambulatory heart rate range () compared with other parameters obtained from the Holter monitor in patients with newly diagnosed AF. Material and Methods: A total of 30 parameters obtained from 521 persistent AF patients’ Holter monitor were analyzed retrospectively from 1 January 2010 to 31 July 2014. Every patient was followed up to the occurrence of death or the end of 30 June 2017. Results: was the most feasible Holter parameter. Lower was associated with increased risk of all-cause mortality (adjusted hazard ratio [aHR] for every 10-bpm reduction: 2.70, 95% confidence interval [CI]: 1.75–4.17, p < 0.001). The C-statistic of alone was 0.707 (95% CI: 0.658–0.756), and 0.697 (95% CI: 0.650–0.744) for the CHA2DS2-VASc score alone. By combining with the CHA2DS2-VASc score, the C-statistic could improve to 0.764 (95% CI: 0.722–0.806). While using 20 bpm as the cut-off value, the aHR was 3.66 (95% CI: 2.05–6.52) for patients with < 20 bpm in contrast to patients with ≥ 20 bpm. Conclusions: could be helpful for risk stratification for AF in addition to the CHA2DS2-VASc score.

Highlights

Atrial fibrillation (AF), a common and severe rhythm disturbance, is associated with increased mortality and morbidity [1]
Amongst 37 parameters calculated from the Holter monitor signals, four Holter parameters remained: AHRR24hr, median, ambulatory heart rate (AHR) at nighttime, singular value1 of f-waves at nighttime, and time-weighted median RR at nighttime (Supplementary Materials Files S2–S6)
We presented the potential of using AHRR24hr acquired from the first Holter monitor to predict all-cause mortality among newly diagnosed atrial fibrillation (AF) patients

Summary

Introduction

Atrial fibrillation (AF), a common and severe rhythm disturbance, is associated with increased mortality and morbidity [1]. The association between the CHA2DS2-VASc score and the death of CHF patients with AF was reported [8]. A few studies applied measurements of ventricular irregularity for predicting mortality in patients with AF, such as entropy measured from 24-h ambulatory ECG recordings, the heart rate variability triangular index (HRVI), and the square root of the mean squared difference of continuous normal-to-normal intervals (RMSSD) [6,15,16]. This study aims to explore the associations between all-cause mortality and the median hourly ambulatory heart rate range (AHRR24hr) compared with other parameters obtained from the Holter monitor in patients with newly diagnosed AF. By combining AHRR24hr with the CHA2DS2-VASc score, the C-statistic could improve to 0.764 (95% CI: 0.722–0.806). Conclusions: AHRR24hr could be helpful for risk stratification for AF in addition to the CHA2DS2-VASc score

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