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Background:  The application of heart rate variability is problematic in patients with atrial fibrillation (AF). This study aims to explore the associations between all-cause mortality and the median hourly ambulatory heart rate range (A  H  R  R   ˜24  h  r) compared with other parameters obtained from the Holter monitor in patients with newly diagnosed AF.  Material and Methods:  A total of 30 parameters obtained from 521 persistent AF patients’ Holter monitor were analyzed retrospectively from 1 January 2010 to 31 July 2014. Every patient was followed up to the occurrence of death or the end of 30 June 2017.  Results:A  H  R  R   ˜24  h  rwas the most feasible Holter parameter. LowerA  H  R  R   ˜24  h  rwas associated with increased risk of all-cause mortality (adjusted hazard ratio [aHR] for every 10-bpm reduction: 2.70, 95% confidence interval [CI]: 1.75–4.17,  p  < 0.001). The C-statistic ofA  H  R  R   ˜24  h  ralone was 0.707 (95% CI: 0.658–0.756), and 0.697 (95% CI: 0.650–0.744) for the CHA2DS2-VASc score alone. By combiningA  H  R  R   ˜24  h  rwith the CHA2DS2-VASc score, the C-statistic could improve to 0.764 (95% CI: 0.722–0.806). While using 20 bpm as the cut-off value, the aHR was 3.66 (95% CI: 2.05–6.52) for patients withA  H  R  R   ˜24  h  r< 20 bpm in contrast to patients withA  H  R  R   ˜24  h  r≥ 20 bpm.  Conclusions:A  H  R  R   ˜24  h  rcould be helpful for risk stratification for AF in addition to the CHA2DS2-VASc score.

Is the Median Hourly Ambulatory Heart Rate Range Helpful in Stratifying Mortality Risk among Newly Diagnosed Atrial Fibrillation Patients?