Key result
Early P-on-T complexes on Holter monitoring are strongly linked to paroxysmal atrial fibrillation.
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?
Case-Control (n=196)
No
Can specific 24-hour Holter ECG monitoring parameters predict paroxysmal atrial fibrillation in asymptomatic patients with sinus rhythm?
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.
Answers are grounded in this paper and cite their sources.
May support PAF prediction from routine Holter data; leaves open prospective validation before clinical adoption.
Objective: To create a tool for the prediction of paroxysmal atrial fibrillation (PAF) in patients with sinus rhythm. Methods: Single-center, case-control study. None of the patients had a prior diagnosis of AF or reported symptoms of heart arrhythmias. Among the cohort of 6,630 individuals, paroxysms of AF were incidentally detected during 24-hours Holter ECG monitoring in 97 patients (main group). The control group - 99 patients from the same primary cohort without PAF. We assessed supraventricular and ventricular ectopic activity, the presence of pauses and blocks, changes of ST segment, QT interval durations, and heart rate variability. Results: We formulated a regression equation to estimate the probability of PAF in patients with sinus rhythm. The most significant risk predictors: early "P on T" premature ectopic complexes (p<0.0001); coupled premature ventricular ectopic complexes (p=0.021); ventricular allorhythmias (OR=0.997). Other analyzed factors, including the frequency of both atrial and atrioventricular premature ectopic complexes, as well as single ventricular ectopic complexes, did not exhibit a statistically significant effect on the risk of PAF, according to this model. Conclusion: The final regression equation, based on the evaluation of data from 24-hours Holter ECG monitoring, incorporates the following criteria: gender, the number of atrial and atrioventricular supraventricular complexes, the count of single and paired ventricular complexes, variations in rhythms with ventricular complexes, as well as the presence or absence of early "P on T" complexes (AUC=0.996).
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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.
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