# Heart Rate Variability Nomogram Predicts Atrial Fibrillation in Patients with Moderate to High Burden of Premature Ventricular Complexes

## TL;DR

This study shows that heart rate variability (HRV) can predict atrial fibrillation in patients with frequent premature ventricular contractions.

## Contribution

A novel HRV-based nomogram is developed to predict AF risk in patients with moderate to high PVC burden.

## Key findings

- 16% of patients with high PVC burden developed new-onset AF.
- HRV parameters like PNN50, SDNN, and LF were significantly higher in AF patients.
- The nomogram provides clinical benefit for AF detection when baseline risk exceeds 15%.

## Abstract

Background and Objectives: There is a well-established correlation between premature ventricular contractions (PVCs) and atrial fibrillation (AF), with a higher burden of PVCs increasing the likelihood of new-onset AF. This study aims to investigate the impact of heart rate variability (HRV) on the onset of AF in patients with moderate to high burdens of PVCs, as observed through 24 h ambulatory electrocardiogram (ECG) analysis. Materials and Methods: Our study was a retrospective analysis involving 187 patients at a single tertiary center. We analyzed PVC counts from 24 h ECG recordings, categorizing the patients into groups based on whether they developed AF or not. Additionally, we developed a nomogram to estimate the risk of AF development in these patients. Results: A new-onset AF was detected in 16% of the cohort. Analysis of 24 h ambulatory ECG data revealed statistically significant increases in the SDNN index, RMSSD, PNN50, total power (TP), and low-frequency (LF) values in AF patients. To estimate the risk of AF, a risk prediction nomogram was created using high-frequency (HF), LF, SDNN index, and PNN50. Among these variables, PNN50 was identified as the strongest predictor in the multivariable model. Additionally, a decision curve analysis demonstrated that the nomogram offers a net clinical benefit for detecting AF in patients when the baseline threshold risk exceeds 15%. Conclusions: Our study found that among patients with AF who had a moderate to high burden of PVCs using 24 h ambulatory ECGs, several HRV parameters were elevated. This increased autonomic instability may play a role in the development and persistence of AF episodes.