open access

Vol 79, No 3 (2021)
Original article
Published online: 2021-02-17
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The importance of the longest R-R interval on 24-hour electrocardiography for mortality prediction in patients with atrial fibrillation

Dorota Zyśko, Anders Persson, Marta Obremska, Marcin Leśkiewicz, Artur Fedorowski, Richard Sutton, Linda SB Johnson
DOI: 10.33963/KP.15820
·
Pubmed: 33599460
·
Kardiol Pol 2021;79(3):311-318.

open access

Vol 79, No 3 (2021)
Original article
Published online: 2021-02-17

Abstract

Background: Heart rate control in atrial fibrillation (AF) is typically assessed by 24‑hour electrocardiography (ECG). There are scarce data on the use of 24‑hour ECG parameters to predict mortality in patients with AF.

Aims: We aimed to identify 24‑hour ECG parameters that predict mortality in patients with AF.

Methods: We enrolled 280 ambulatory patients (mean [SD] age, 72 [8.7] years; 57.9% men) with permanent or persistent AF. Data on mortality and pacemaker or defibrillator implantation during follow‑up were collected. Predictors of mortality were assessed using the Cox proportional hazards model and C statistic.

Results: Compared with survivors, 78 patients (28%) who died were older, more often had comorbidities, left bundle branch block (LBBB), reduced left ventricular ejection fraction, lower maximum heart rate, higher number of ventricular extrasystoles, and the longest R‑R interval below 2 seconds. Univariate analysis showed higher mortality in patients with the longest R‑R intervals below 2 seconds compared with those with R‑R intervals of 2 seconds or longer (P < 0.001). Independent mortality predictors in the regression model included older age, renal failure, history of coronary intervention, chronic obstructive pulmonary disease, LBBB, and a high number (≥770) or absence of R‑R intervals of at least 2 seconds. The area under the curve for mortality prediction increased after including ECG parameters (0.748; 95% CI, 0.686–0.81; vs 0.688; 95% CI, 0.618–0.758; P = 0.02).

Conclusions: A high number of R‑R intervals longer than 2 seconds or their absence on 24‑hour ECG may predict mortality in patients with AF.

Abstract

Background: Heart rate control in atrial fibrillation (AF) is typically assessed by 24‑hour electrocardiography (ECG). There are scarce data on the use of 24‑hour ECG parameters to predict mortality in patients with AF.

Aims: We aimed to identify 24‑hour ECG parameters that predict mortality in patients with AF.

Methods: We enrolled 280 ambulatory patients (mean [SD] age, 72 [8.7] years; 57.9% men) with permanent or persistent AF. Data on mortality and pacemaker or defibrillator implantation during follow‑up were collected. Predictors of mortality were assessed using the Cox proportional hazards model and C statistic.

Results: Compared with survivors, 78 patients (28%) who died were older, more often had comorbidities, left bundle branch block (LBBB), reduced left ventricular ejection fraction, lower maximum heart rate, higher number of ventricular extrasystoles, and the longest R‑R interval below 2 seconds. Univariate analysis showed higher mortality in patients with the longest R‑R intervals below 2 seconds compared with those with R‑R intervals of 2 seconds or longer (P < 0.001). Independent mortality predictors in the regression model included older age, renal failure, history of coronary intervention, chronic obstructive pulmonary disease, LBBB, and a high number (≥770) or absence of R‑R intervals of at least 2 seconds. The area under the curve for mortality prediction increased after including ECG parameters (0.748; 95% CI, 0.686–0.81; vs 0.688; 95% CI, 0.618–0.758; P = 0.02).

Conclusions: A high number of R‑R intervals longer than 2 seconds or their absence on 24‑hour ECG may predict mortality in patients with AF.

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About this article
Title

The importance of the longest R-R interval on 24-hour electrocardiography for mortality prediction in patients with atrial fibrillation

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 79, No 3 (2021)

Article type

Original article

Pages

311-318

Published online

2021-02-17

DOI

10.33963/KP.15820

Pubmed

33599460

Bibliographic record

Kardiol Pol 2021;79(3):311-318.

Authors

Dorota Zyśko
Anders Persson
Marta Obremska
Marcin Leśkiewicz
Artur Fedorowski
Richard Sutton
Linda SB Johnson

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