What question did this study set out to answer?

To develop an electrocardiographic risk prediction model for paroxysmal atrial fibrillation in patients with preserved sinus rhythm and no prior arrhythmia history.

May 7, 2026Journal of Clinical Medicine of KazakhstanOpen Access

The presence of early "P on T" premature ectopic complexes on 24-hour Holter ECG monitoring was associated with a substantially increased likelihood of paroxysmal atrial fibrillation (OR 8461.648).

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Paroxysmal atrial fibrillation (n=196). Intervention: Early "P on T" premature ectopic complexes vs. Absence of early "P on T" premature ectopic complexes. Primary outcome: Paroxysmal atrial fibrillation (OR 8461.648, 95% CI 382.1983-187336, p=<0.0001).

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Why the study?

The study was conducted to create a tool for the prediction of paroxysmal atrial fibrillation in patients with sinus rhythm.

Can specific 24-hour Holter ECG monitoring parameters predict paroxysmal atrial fibrillation in asymptomatic patients with sinus rhythm?

Population

97 patients with incidentally detected PAF and 99 controls from a cohort of 6,630 individuals

Comparison

Patients with incidentally detected PAF vs controls without PAF

Design

Single-center case-control study

Key result

The presence of early "P on T" premature ectopic complexes on 24-hour Holter ECG monitoring was associated with a substantially increased likelihood of paroxysmal atrial fibrillation (OR 8461.648).

Authors

OGOlga A Germanova YRYulia Reshetnikova AGAndrey Germanov

Discussion

Member takes

Overview

May support PAF prediction from routine Holter data; leaves open prospective validation before clinical adoption.

Key Points

To develop an electrocardiographic risk prediction model for paroxysmal atrial fibrillation in patients with preserved sinus rhythm and no prior arrhythmia history.
Conducted a single-center case-control study screening a cohort of 6,630 individuals undergoing 24-hour Holter ECG monitoring.
Compared 97 patients with incidentally detected paroxysmal atrial fibrillation against 99 controls without paroxysmal episodes.
Evaluated supraventricular and ventricular ectopic activity, cardiac pauses, conduction blocks, ST-segment deviations, QT intervals, and heart rate variability.
Early 'P on T' premature ectopic complexes (p < 0.0001) and coupled premature ventricular ectopic complexes (p = 0.021; ventricular allorhythmias OR = 0.997) emerged as the strongest predictors.
Isolated atrial, atrioventricular, and single ventricular premature ectopic complexes showed no statistically significant association with paroxysmal atrial fibrillation risk.
A multivariable regression model incorporating sex, supraventricular counts, ventricular complex patterns, and early 'P on T' complexes achieved an area under the curve of 0.996.

Study Design

Type

Case-Control (n=196)

Multicenter

Structured PICO

Can specific 24-hour Holter ECG monitoring parameters predict paroxysmal atrial fibrillation in asymptomatic patients with sinus rhythm?

Population

196 hospitalized patients without a prior diagnosis of atrial fibrillation, including 97 with incidentally detected paroxysmal atrial fibrillation and 99 matched controls, evaluated via 24-hour Holter ECG.

Exposure

24-hour Holter ECG monitoring parameters (supraventricular and ventricular ectopic activity, pauses, blocks, ST segment changes, QT interval durations, and heart rate variability)

Comparator

Patients without paroxysmal atrial fibrillation (control group)

Outcome

Probability/prediction of paroxysmal atrial fibrillationsurrogate

Main Result

Odds Ratio: 8461.648 (95% CI 382.1983–187336)

p-value: p=<0.0001

A regression model incorporating specific Holter ECG parameters, notably early 'P on T' complexes, can highly accurately predict incidentally detected paroxysmal atrial fibrillation in asymptomatic patients with sinus rhythm.

Limitations

Single-center, case-control design introduces a significant risk of selection bias.
Limited cohort size, particularly of patients with PAF, reduces statistical power.
Potential for model overfitting, as suggested by high AUC.
Lack of external validation.

Cite This Study

Germanova et al. (2026) conducted a case-control in Paroxysmal atrial fibrillation (n=196). Early "P on T" premature ectopic complexes vs. Absence of early "P on T" premature ectopic complexes was evaluated on Paroxysmal atrial fibrillation (OR 8461.648, 95% CI 382.1983-187336, p=<0.0001). The presence of early "P on T" premature ectopic complexes on 24-hour Holter ECG monitoring was associated with a substantially increased likelihood of paroxysmal atrial fibrillation (OR 8461.648).

synapsesocial.com/papers/6a978ded827cb52371a66aea https://doi.org/10.23950/jcmk/18532

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May 7, 2026Journal of Clinical Medicine of KazakhstanOpen Access

The presence of early "P on T" premature ectopic complexes on 24-hour Holter ECG monitoring was associated with a substantially increased likelihood of paroxysmal atrial fibrillation (OR 8461.648).

View Full Paper

Ask AI

Bookmark

Why the study?

The study was conducted to create a tool for the prediction of paroxysmal atrial fibrillation in patients with sinus rhythm.

Can specific 24-hour Holter ECG monitoring parameters predict paroxysmal atrial fibrillation in asymptomatic patients with sinus rhythm?

Population

97 patients with incidentally detected PAF and 99 controls from a cohort of 6,630 individuals

Comparison

Patients with incidentally detected PAF vs controls without PAF

Design

Single-center case-control study

Key result

The presence of early "P on T" premature ectopic complexes on 24-hour Holter ECG monitoring was associated with a substantially increased likelihood of paroxysmal atrial fibrillation (OR 8461.648).

Authors

OGOlga A Germanova YRYulia Reshetnikova AGAndrey Germanov

Discussion

Member takes

Overview

May support PAF prediction from routine Holter data; leaves open prospective validation before clinical adoption.

Key Points

To develop an electrocardiographic risk prediction model for paroxysmal atrial fibrillation in patients with preserved sinus rhythm and no prior arrhythmia history.
Conducted a single-center case-control study screening a cohort of 6,630 individuals undergoing 24-hour Holter ECG monitoring.
Compared 97 patients with incidentally detected paroxysmal atrial fibrillation against 99 controls without paroxysmal episodes.
Evaluated supraventricular and ventricular ectopic activity, cardiac pauses, conduction blocks, ST-segment deviations, QT intervals, and heart rate variability.
Early 'P on T' premature ectopic complexes (p < 0.0001) and coupled premature ventricular ectopic complexes (p = 0.021; ventricular allorhythmias OR = 0.997) emerged as the strongest predictors.
Isolated atrial, atrioventricular, and single ventricular premature ectopic complexes showed no statistically significant association with paroxysmal atrial fibrillation risk.
A multivariable regression model incorporating sex, supraventricular counts, ventricular complex patterns, and early 'P on T' complexes achieved an area under the curve of 0.996.

Study Design

Type

Case-Control (n=196)

Multicenter

Structured PICO

Can specific 24-hour Holter ECG monitoring parameters predict paroxysmal atrial fibrillation in asymptomatic patients with sinus rhythm?

Population

Exposure

24-hour Holter ECG monitoring parameters (supraventricular and ventricular ectopic activity, pauses, blocks, ST segment changes, QT interval durations, and heart rate variability)

Comparator

Patients without paroxysmal atrial fibrillation (control group)

Outcome

Probability/prediction of paroxysmal atrial fibrillationsurrogate

Main Result

Odds Ratio: 8461.648 (95% CI 382.1983–187336)

p-value: p=<0.0001

Limitations

Single-center, case-control design introduces a significant risk of selection bias.
Limited cohort size, particularly of patients with PAF, reduces statistical power.
Potential for model overfitting, as suggested by high AUC.
Lack of external validation.

Cite This Study

synapsesocial.com/papers/6a978ded827cb52371a66aea https://doi.org/10.23950/jcmk/18532

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