Issue: 2025, Vol. 30, No. 3

A. V. Muromkina

SIGNIFICANCE OF STRUCTURAL CHANGES AND HEART RATE VARIABILITY IN TREATMENT OF PERMANENT ATRIAL FIBRILLATION

Keywords

atrial fibrillation, heart rate variability, effectiveness of heart rate control

Abstarct

Monitoring the heart rate (HR) is one of the approaches to treating persistent atrial fibrillation (AF). Both structural remodelling of the atria and features of autonomic regulation of the heart play a role in maintaining AF. Objective – to study the relationship between structural changes in the heart and the characteristics of heart rate variability (HRV) in order to develop a method for predicting the HR control effectiveness in patients with permanent AF.Т. 30, No 3, 2025 Quid est Veritas? 19 Material and Methods. One hundred twenty four patients with permanent AF were examined, their aver- age age being 61.2 ± 11.0. Echocardiography and Holter ECG monitoring (HECGM) were performed to calculate how well the heart rate was controlled by the original method, and to assess HRV parameters. The patients were divided into two groups for further analysis: 37 patients with no structural changes in the heart (patients with hypertension and idiopathic AF) and 87 patients with such changes (coronary artery disease (CAD), rheumatic heart disease). Results and Discussion. Patients with structural changes in the heart showed more pronounced left atrial (LA) dilatation and left ventricular (LV) hypertrophy compared to those without structural changes in the heart. Differences between the groups were identified due to the geometric analysis of HRV: HRV index (triangular index) and TINN (triangular interpolation index of the R-R interval histogram). The patients with AF and effective HR control had higher pNN50% values (the number of pairs of adjacent NN intervals differing by more than 50 ms in terms of the percentage of the total number of NN intervals in the sample) compared to the patients with ineffective HR control, despite the presence of structural changes in the heart. Conclusion. The identified correlations between structural changes in the heart and HRV parameters allowed developing a model to predict the effectiveness of HR control in patients with permanent AF. The model was introduced as a computer program that optimised pulse-reducing therapy choice in such patients.

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