Repeatability of ectopic beats from 48‐hr ambulatory electrocardiography: The Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Background The purpose of this study was to characterize the repeatability of ectopic beats, defined by premature atrial contractions (PACs) and premature ventricular contractions (PVCs), on ambulatory electrocardiogram (aECG) monitoring and evaluate the effect of length of aECG monitoring on the repeatability estimates. Methods This analysis includes 95 randomly selected participants from the Atherosclerosis Risk in Communities Study (ARIC; 2011–2013). The participants wore a Holter monitor for two, 48-hour periods separated by a mean of 38 days following an identical, standardized protocol. We divided each 48-hour recording into 3-, 6-, 12-, and 24-hour recording periods and calculated intraclass correlation coefficients (ICCs) for PACs and PVCs and also as a percentage of the corresponding total of recorded beats per hour among these periods. Results All participants had ≥1 PAC during the 48-hour recordings, and only 2 participants had no PVCs. ICCs were >0.83 for all indices and recording lengths ≥12 hours. ICCs were intermediate for 6-hour recordings (range 0.80 to 0.83) and lower for 3-hour recordings (range 0.74 to 0.80). The ratio of the between- to within-participant variation increased with recording length. Conclusion Repeatability of PACs and PVCs was excellent for recording lengths of 6–24 hours and fair for 3 hours. Repeatability varies over shorter duration recordings within the 48-hour recording period, thus the present results have implications for detection algorithms for ectopic beats and can facilitate epidemiologic and clinical applications in which knowledge of measurement variability and misclassification are needed.

Yield and consistency of arrhythmia detection with patch electrocardiographic monitoring: The Multi-Ethnic Study of Atherosclerosis

“…Limited information is available from general population studies about the consistency of estimates of supraventricular and ventricular ectopy with extended or repeat recording. A previous analysis of data from two 48-hour Holter monitors worn an average of 38 days apart in the Atherosclerosis Risk in Communities study showed high agreement for PAC and PVC counts per hour when repeated recording periods of 3 hours were considered (ICCs 0.80 and 0.74, respectively) and even better agreement for repeated recording periods of 24 hours (ICCs 0.84 and 0.84, respectively) [11]. Our findings extend these observations to longer recording periods, demonstrating very high consistency in findings for two recording periods of an average of 12 days each (ICCs 0.88 and 0.82, respectively).…”

Ambulatory Electrocardiographic Monitoring and Ectopic Beat Detection in Conscious Mice

“…The European Society of Cardiology guidelines suggest that patients who have arrhythmia-related symptoms should receive a 24-h ambulatory ECG, in order to detect potential detrimental ventricular arrhythmia and conduction disorders and preventing SCD [ 6 , 7 ]. The most common finding on AECG are ectopic heart beats: premature atrial complexes (PACs) and premature ventricular complexes (PVCs) originating from the atrial and ventricular myocardium, respectively [ 8 ]. AECG allows for quantification of PACs and PVCs, respectively called “PAC or PVC burden” wherein the number of PACs or PVCs is expressed as a percentage of the total number of recorded heartbeats.…”