Heart rate fragmentation is a new novel predictor in predicting the recurrence of atrial fibrillation after catheter ablation for atrial fibrillation

Background Traditional heart rate variability (HRV) analysis has been used to predict the recurrence of atrial fibrillation (AF) after catheter ablation for AF, but its prognostic value is limited. Heart rate fragmentation (HRF), a recently introduced method that quantifies beat-to-beat irregularity in cardiac interbeat intervals, has been associated with adverse cardiovascular events and with the development of atrial fibrillation in the general population. Several studies have shown that HRF outperforms conventional HRV indices in predicting clinical outcomes. Purpose This study aimed to investigate whether the HRF values after AF catheter ablation could predict the recurrence of AF. Methods This study enrolled the 143patients who underwent AF radiofrequency catheter ablation (RFCA). HRF and HRV were assessed from a 24-hour Holter monitoring acquired on the day after RFCA. The primary outcome was the development of AF. Results A total of 143 patients (mean age, 57.1 ± 12.9 years; male, 58.3%; paroxysmal AF, 54%) underwent AF RFCA and 24-hour Holter monitoring were analyzed. During an average follow-up of 37.6 months, 34 patients developed AF. Higher percentage of inflection points (PIP, P<0.001) as HRF parameter and higher HRV parameters including high-frequency (P = 0.02) and the square root of the mean squared differences (P=0.01) were associated with the development of AF. Conclusion The HRF value, especially PIP, is better predictor for AF recurrence after AF RFCA.