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

Zyśko, Dorota ; Persson, Anders LU orcid ; Obremska, Marta ; Leśkiewicz, Marcin ; Fedorowski, Artur LU orcid ; Sutton, Richard and Johnson, Linda SB LU (2021) In Kardiologia Polska
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 AF.

AIMS: We aimed to identify 24-hour ECG parameters that predict mortality in AF.

METHODS: We enrolled 280 ambulatory patients (mean [SD] age, 72.0 [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 (28%) patients who died were older, more often had comorbidities, left bundle branch block... (More)

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 AF.

AIMS: We aimed to identify 24-hour ECG parameters that predict mortality in AF.

METHODS: We enrolled 280 ambulatory patients (mean [SD] age, 72.0 [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 (28%) patients who died were older, more often had comorbidities, left bundle branch block (LBBB), reduced left ventricular ejection fraction, lower maximum heart rate, a higher number of ventricular extrasystoles, and the longest R-R interval below 2 seconds. Univariate analysis revealed higher mortality in patients with the longest R-R intervals below 2 seconds compared with those with the 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 curve (AUC) for mortality prediction increased after inclusion of ECG parameters 0.748 [95% CI, 0.686-0.810] 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 AF.

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Please use this url to cite or link to this publication:
author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Kardiologia Polska
publisher
Polskie Towarzystwo Kardiologiczne
external identifiers
  • scopus:85103607897
  • pmid:33599460
ISSN
1897-4279
DOI
10.33963/KP.15820
language
English
LU publication?
yes
id
2a6d75df-29f3-4001-9739-0a2a72fa30af
date added to LUP
2021-02-26 12:05:38
date last changed
2025-01-11 05:32:47
@article{2a6d75df-29f3-4001-9739-0a2a72fa30af,
  abstract     = {{<p>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 AF.</p><p>AIMS: We aimed to identify 24-hour ECG parameters that predict mortality in AF.</p><p>METHODS: We enrolled 280 ambulatory patients (mean [SD] age, 72.0 [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.</p><p>RESULTS: Compared with survivors, 78 (28%) patients who died were older, more often had comorbidities, left bundle branch block (LBBB), reduced left ventricular ejection fraction, lower maximum heart rate, a higher number of ventricular extrasystoles, and the longest R-R interval below 2 seconds. Univariate analysis revealed higher mortality in patients with the longest R-R intervals below 2 seconds compared with those with the R-R intervals of 2 seconds or longer (P &lt;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 curve (AUC) for mortality prediction increased after inclusion of ECG parameters 0.748 [95% CI, 0.686-0.810] vs 0.688 [95% CI, 0.618-0.758]; P = 0.02).</p><p>CONCLUSIONS: A high number of R-R intervals longer than 2 seconds or their absence on 24-hour ECG may predict mortality in AF.</p>}},
  author       = {{Zyśko, Dorota and Persson, Anders and Obremska, Marta and Leśkiewicz, Marcin and Fedorowski, Artur and Sutton, Richard and Johnson, Linda SB}},
  issn         = {{1897-4279}},
  language     = {{eng}},
  month        = {{02}},
  publisher    = {{Polskie Towarzystwo Kardiologiczne}},
  series       = {{Kardiologia Polska}},
  title        = {{The importance of the longest R-R interval on 24-hour electrocardiography in mortality prediction in patients with atrial fibrillation}},
  url          = {{http://dx.doi.org/10.33963/KP.15820}},
  doi          = {{10.33963/KP.15820}},
  year         = {{2021}},
}