Predictive value of electrocardiographic repolarization parameters and HRV parameters for new-onset atrial fibrillation in patients with acute myocardial infarction

Wang Danfeng

Ding Yao

Gong Fanying

Situ Qiushun

Du Xinzhi

Huang Yang

Department of Functional Examination,Affiliated Hospital of Nanjing University of Chinese Medicine

Abstract:Objective To investigate the characteristics of electrocardiographic repolarization parameters and heart rate variability(HRV) parameters in patients with acute myocardial infarction(AMI) at admission and their predictive value for new-onset atrial fibrillation. Methods A total of 110 AMI patients admitted to the Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine between January 2024 and March 2025 were enrolled. Based on the occurrence of new-onset atrial fibrillation during hospitalization and 3-month follow-up, patients were categorized into an atrial fibrillation group(n = 17) and a non-atrial fibrillation group(n = 93). Baseline data, electrocardiographic repolarization parameters(QT interval, QTc interval, Tp-e interval, Tp-e/QT ratio), and HRV parameters [standard deviation of all normal RR intervals over 24 hours(SDNN), root mean square of successive RR interval differences(RMSSD), standard deviation of average RR intervals in 5-minute segments over 24 hours(SDANN), low-frequency power(LF), high-frequency power(HF),and LF/HF ratio] were compared between the two groups. Multivariate logistic regression analysis was employed to identify independent predictors of new-onset atrial fibrillation in AMI patients. Receiver operating characteristic(ROC) curve analysis was used to evaluate the predictive performance of individual and combined parameters for new-onset atrial fibrillation risk in AMI patients. Results Among the 110 AMI patients, 17(15.5%) developed new-onset atrial fibrillation. Compared with the non-atrial fibrillation group, the atrial fibrillation group exhibited a longer interval from symptom onset to admission, higher proportions of Killip class II, and elevated peak levels of troponin I and CK-MB(t/χ2= 2.477, 3.281, 2.095; P = 0.015, 0.033,0.001, 0.038). Additionally, the atrial fibrillation group demonstrated significantly longer QTc intervals, Tp-e intervals, higher Tp-e/QT ratios, LF, and LF/HF ratios, along with lower SDNN, RMSSD, SDANN, and HF values(t = 4.352, 5.430, 4.196,4.072, 3.413, 5.050, 2.886, 5.873, 6.254; all P<0.001). After correcting for Killip grade and troponin I peak, multivariate logistic regression analysis still showed that longer QTc interval [OR(95%CI) = 1.067(1.016-1.121)], longer Tp-e interval [OR(95%CI) = 5.772(1.455-22.894)], and higher LF/HF ratio [OR(95%CI) = 8.332(1.973-35.184)]were independent risk factors for new-onset atrial fibrillation in AMI patients, while longer SDNN [OR(95%CI) = 0.941(0.904-0.981)]was an independent protective factor(all P<0.05). ROC curve analysis showed that the AUCs of QTc interval, Tp-e interval, LF/HF,SDNN, and their combination for predicting new-onset atrial fibrillation in AMI patients were 0.788, 0.782, 0.802, 0.857, and0.930, respectively. The combined prediction was superior to each individual parameter(Z/P = 3.204/0.015, 3.252/0.014, 2.702/0.031, 2.403/0.035). Conclusion Early admission electrocardiographic repolarization parameters and HRV parameters are independent predictors of new-onset atrial fibrillation in AMI patients. The combination of these two parameter categories offers enhanced predictive efficacy, providing a theoretical basis and clinical reference for early identification of high-risk AMI patients prone to new-onset atrial fibrillation.

Keyword:Acute myocardial infarctionAtrial fibrillationElectrocardiographic repolarization parametersHeart rate variabilityPredictive value

Fund:Science and Technology Project of Jiangsu Administration of Traditional Chinese Medicine (JD2022sz09)

Authors:*黄洋,E-mail:511933106@qq.com;