Article 1-4

ORIGINAL RESEARCH ARTICLE

Episodes of High-Rate Atrial Activity as a Manifestation of the Continuum of Atrial Tachyarrhythmias and Their Association With the Duration of Atrial Fibrillation Episodes

Danilevych, T.D., MD, PhD1; Rasputina, L.V., MD, PhD, ScD2; Didenko, D.V., MD, PhD3

1Cardiologist, Vinnytsia Regional Center for Cardiovascular Pathology: Associate Professor, Department of Propaedeutics of Internal Medicine, National Pirogov Memorial Medical University, Vinnytsya, Ukraine

2Сardiologist, Professor, Department of Propaedeutics of Internal Medicine, National Pirogov Memorial Medical University, Vinnytsya, Ukraine.

3Cardiologist, Assistant Professor of the Department of Propaedeutics of Internal Medicine, National Pirogov Memorial Medical University, Vinnytsya, Ukraine

Heart and Circulation Research. 1(1):33-49, April 2026.

Abstract

Objective: To improve prediction of electrocardiographic characteristics associated with sustained paroxysms of atrial fibrillation (AF) (≥30 seconds) based on 24-hour Holter ECG monitoring.

Materials and Methods: A retrospective, single-center, observational study was conducted, including the analysis of 24-hour Holter ECG recordings from 171 patients (mean age 62.6 ± 10.2 years). Depending on the duration of atrial arrhythmic episodes, patients were divided into two groups: atrial high-rate episodes (AHRE) <30 seconds (n = 137) and sustained paroxysms of AF ≥30 seconds (n = 34). Heart rate parameters, atrial and ventricular ectopic activity, conduction parameters, and repolarization indices were assessed. Statistical analysis included correlation analysis and multivariable logistic regression.

Results: Sustained paroxysms of AF ≥30 seconds were associated with a greater number of supraventricular premature beats (r = 0.230; p = 0.003), as well as higher mean 24-hour (r = 0.182; p = 0.017), mean daytime (r = 0.208; p = 0.006), and maximum heart rate values (r = 0.213; p = 0.005). In multivariable logistic regression, independent factors associated with sustained paroxysms of AF included moderate supraventricular ectopic activity (5000–10000 beats/day; odds ratio [OR] 4.21; 95% confidence interval [CI] 1.08–16.42), mean 24-hour heart rate (OR 1.03 per 1 beat/min), and the presence of first-degree atrioventricular block (OR 2.74; 95% CI 1.02–7.33). QT/QTc intervals and QRS complex duration did not retain independent associations after multivariable adjustment.

Conclusions: Episodes of high-rate atrial activity are associated with electrophysiological changes characteristic of AF progression and may be considered an early stage of the atrial tachyarrhythmia continuum. Analysis of supraventricular ectopic activity, mean 24-hour heart rate, and atrioventricular conduction allows identification of patients with AHRE who are at increased risk of developing sustained paroxysms of AF.

Keywords

Atrial high-rate episodes; Atrial fibrillation; 24-hour Holter ECG monitoring; Arrhythmias; Cardiovascular diseases

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