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Repeatability of ectopic beats from 48-hr ambulatory electrocardiography: The Atherosclerosis Risk in Communities
Michelle L Meyer1, Elsayed Z Soliman2, Lisa M Wruck3
1University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Insights
Repeatability of ectopic beats, including premature atrial contractions (PACs) and premature ventricular contractions (PVCs), is excellent with 6-24 hour ambulatory electrocardiogram (aECG) monitoring. Shorter 3-hour recordings show fair repeatability, highlighting the importance of monitoring duration for accurate ectopic beat detection.
Area of Science:
- Cardiology
- Biomedical Engineering
- Epidemiology
Background:
- Ectopic heartbeats, such as premature atrial contractions (PACs) and premature ventricular contractions (PVCs), are common cardiac events.
- Assessing the repeatability of these events using ambulatory electrocardiogram (aECG) monitoring is crucial for clinical and epidemiological applications.
- Understanding how monitoring duration affects repeatability estimates is essential for optimizing aECG use.
Purpose of the Study:
- To characterize the repeatability of PACs and PVCs detected via aECG monitoring.
- To evaluate the impact of aECG monitoring length on the repeatability of ectopic beat detection.
Main Methods:
- Analysis of 95 participants from the Atherosclerosis Risk in Communities Study (ARIC).
- Two 48-hour Holter monitor recordings were obtained per participant, separated by approximately 38 days.
- Intraclass correlation coefficients (ICCs) were calculated for PACs and PVCs using 3-, 6-, 12-, and 24-hour segments of the 48-hour recordings.
Main Results:
- Excellent repeatability (ICCs >0.83) for PACs and PVCs was observed for recording lengths of 12 hours and longer.
- Intermediate repeatability (ICCs 0.80-0.83) was found for 6-hour recordings.
- Fair repeatability (ICCs 0.74-0.80) was noted for 3-hour recordings, with higher between- to within-participant variation as recording length increased.
Conclusions:
- Repeatability of PACs and PVCs is excellent for 6-24 hour aECG monitoring durations and fair for 3-hour recordings.
- Variability in repeatability across shorter recording durations within a 48-hour period has implications for ectopic beat detection algorithms.
- These findings support improved epidemiologic and clinical applications requiring knowledge of measurement variability and potential misclassification in ectopic beat detection.
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-hr periods separated by a mean of 38 days following an identical, standardized protocol. We divided each 48-hr recording into 3-, 6-, 12-, and 24-hr 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-hr recordings, and only two participants had no PVCs. ICCs were >0.83 for all indices and recording lengths ≥12 hrs. ICCs were intermediate for 6-hr recordings (range 0.80-0.83) and lower for 3-hr recordings (range 0.74-0.80). 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 hr and fair for 3 hr. Repeatability varies over shorter duration recordings within the 48-hr recording period, and 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.
