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

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 (AHRR˜24hr) 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:AHRR˜24hr was the most feasible Holter parameter. Lower AHRR˜24hr 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 AHRR˜24hr 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 AHRR˜24hr 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 AHRR˜24hr < 20 bpm in contrast to patients with AHRR˜24hr ≥ 20 bpm. Conclusions:AHRR˜24hr could be helpful for risk stratification for AF in addition to the CHA2DS2-VASc score.

The Interplay of PR Interval and AV Pacing Delays Used for Cardiac Resynchronization Therapy in Heart Failure Patients: Association with Clinical Response in a Retrospective Analysis of a Large Observational Study

“…Our results do apply to the subgroup of patients with out-of-the-box settings with fixed AV and VV delays; also, our results apply to a population of patients treated in the period 2013-2018 and it is possible that response to CRT in contemporary practice may be better thanks to the progressive use of quadripolar leads and AV optimization algorithms. We analyzed the occurrence of AF > 7 days as a function of PR interval, even if many factors may actually condition AF onset in patients with LV dysfunction and AF [2,27,[31][32][33][34][35]. Additionally, given the observational nature of the study, granular descriptions of specific echocardiographic measurements, such as grade and type of valvular heart disease, were missing.…”

Cardiac Disease: Diagnosis, Treatment, and Outcomes

“…Meanwhile Hsing-Yu Chen et al from Taiwan studied median hourly ambulatory heart rate range among newly diagnosed atrial fibrillation in order to help in risk stratification. The authors’ main conclusion is that a newly-developed parameter—median hourly ambulatory heart rate range (AHRR˜24 h)—could provide an additive value to the well-known CHA 2 DS 2 -VASc score [ 3 ]. Moving towards other topic areas, there is a very interesting paper on the novel diagnostic modality of Discovery NM530c camera using 99 mTc-MIBI for the myocardial blood flow and flow reserve examination in patients with multivessel coronary artery disease.…”