AUTHOR=Moelgg Kurt , Karisik Anel , Buergi Lucie , Scherer Lukas , Delazer Luisa , Dejakum Benjamin , Felicetti Silvia , Koehler Theresa , Granna Julian , Boehme Christian , Pechlaner Raimund , Prock Theresa , Toell Thomas , Bauer Axel , Schreinlechner Michael , Pavluk Daniel , Knoflach Michael , Kiechl Stefan , Mayer-Suess Lukas 
  
TITLE=Value of routine heart rate variability parameters for atrial fibrillation detection in ischaemic stroke and high-risk TIA patients
  
JOURNAL=Frontiers in Stroke
  
VOLUME=Volume 4 - 2025
  
YEAR=2026
  
URL=https://www.frontiersin.org/journals/stroke/articles/10.3389/fstro.2025.1727719
  
DOI=10.3389/fstro.2025.1727719
  
ISSN=2813-3056
  
ABSTRACT=IntroductionUndetected atrial fibrillation (AF) increases the risk of recurrent ischaemic stroke, but current prediction scores do not incorporate heart rate variability (HRV) measures readily available from 24-h Holter ECGs.MethodsIn 697 patients with non-AF ischaemic stroke or non-AF high-risk transient ischaemic attack (TIA) from the STROKE-CARD Registry (NCT04582825), we assessed eight time-domain HRV parameters for predicting incident AF within 1 year. ROC analyses, logistic regression, and the Youden index were used to identify optimal cut-offs and compare HRV performance with Brown-ESUS AF and AS5F scores.ResultsNew-onset AF was detected in 28 patients (4.0%). PNN50, rMSSD, and SDSD showed the best discrimination (AUC = 0.711, 0.766, and 0.775), outperforming both clinical scores (AUC ≤ 0.612). Optimal cut-offs were 5.5% (PNN50), 48.5 ms (rMSSD), and 43.5 ms (SDSD). Dichotomized analyses confirmed strong associations with AF (ORs 5.34–7.70, all p < 0.001), and adding HRV parameters significantly improved prediction beyond existing scores.ConclusionsPNN50, rMSSD, and SDSD from routine Holter ECGs enhance AF risk prediction after non-cardioembolic stroke or high-risk TIA and may support targeted monitoring strategies.