Average heart rate, atrial fibrillation and R-on-T ventricular ectopy in 24h Holter recordings predict all-cause mortality in healthy middle-aged men

Ambulatory ECG recordings contain unique information about heart rate dynamics and arrhythmias. However, little is known about the long-term prognostic value in healthy persons. Here we present results of a 22-year follow-up study in 753 apparently healthy men, age at inclusion 52 ± 6 [40-60] years. In the Holter ECG we determined type and incidence of arrhythmias, minimal, averaged and maximal heart rate (HRmin, HRav, HRmax), averaged standard deviation of normal-to-normal beat intervals (SDNN), standard deviation of the normal-to-normal beat interval averages (SDANN), % successive normal-to-normal beat interval differences exceeding 50 ms (pNN50), and low-frequency heart rate variability in normalized units (LFnu). All cause mortality risk factors were computed by a Cox proportional hazards model. During follow-up 27 persons died. Significantly (P < 0.05) elevated relative risk (RR) was found for atrial fibrillation (RR = 13.8), R-on-T ventricular ectopic beats (RR = 7.0), Hrav (RR = 5.6) and pNN50 (RR = 3.4).