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Diagnostic reliability of monitoring for premature atrial and ventricular complexes

Måneheim, Alexandra LU ; Lundeberg, Johan Economou LU orcid ; Persson, Anders P. LU orcid ; Edegran, Albin LU ; Grotek-Cuprjak, Agnieszka ; Juhlin, Tord LU ; Benezet-Mazuecos, Juan ; Ellenbogen, Kenneth A. ; Engström, Gunnar LU and Healey, Jeff S. , et al. (2024) In Europace 26(8).
Abstract

Aims Short-term ambulatory electrocardiogram (ECG) monitoring is often used to assess premature atrial complex (PAC) and premature ventricular complex (PVC) frequency, but the diagnostic reliability is unknown. The objective of this study was to study the day-to-day variability of PAC and PVC frequency. Methods We used 14-day full-disclosure mobile cardiac telemetry recordings without atrial fibrillation in 8245 US patients aged and results 17-103 years to calculate the diagnostic reliability of shorter ambulatory ECG recordings compared with 14-day averages. Over 14 days, 1853 patients had ≥500 PACs/day, 410 patients had ≥5000 PACs/day, and 197 patients had ≥10 000 PACs/day; 1640 patients had ≥500 PVCs/day, 354 patients had... (More)

Aims Short-term ambulatory electrocardiogram (ECG) monitoring is often used to assess premature atrial complex (PAC) and premature ventricular complex (PVC) frequency, but the diagnostic reliability is unknown. The objective of this study was to study the day-to-day variability of PAC and PVC frequency. Methods We used 14-day full-disclosure mobile cardiac telemetry recordings without atrial fibrillation in 8245 US patients aged and results 17-103 years to calculate the diagnostic reliability of shorter ambulatory ECG recordings compared with 14-day averages. Over 14 days, 1853 patients had ≥500 PACs/day, 410 patients had ≥5000 PACs/day, and 197 patients had ≥10 000 PACs/day; 1640 patients had ≥500 PVCs/day, 354 patients had ≥5000 PVCs/day, and 175 patients had ≥10 000 PVCs/day. After 3 days, the estimated daily PAC frequency differed by ≥50% from the 14-day mean in 25% of patients; for PVCs, the corresponding duration was 7 days. Ten days of monitoring were needed to estimate PAC and PVC frequency within ±20% of the overall 14-day frequency in 80% of patients. For daily PAC and PVC frequencies ≥10 000, single-day estimation had a specificity of 99.3% [95% confidence interval (CI) 99.1-99.5] at a sensitivity of 76.6 (95% CI 70.1-80.4%) for PACs and a 99.6% (95% CI 99.4-99.7%) specificity at 79.4 (95% CI 72.7-85.2) sensitivity for PVCs. After 7 days, the sensitivity increased to 88.8% (95% CI 83.6-92.9) for PACs and 86.9% (95% CI 80.9-91.5%) for PVCs. Conclusion While there is substantial daily variability across most PAC and PVC levels, findings of ≥10 000 PACs or PVCs are highly specific and do not need to be confirmed with longer recordings.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Ambulatory electrocardiography, Diagnostic yield, Mobile cardiac telemetry, Premature atrial complex, Premature ventricular complexes
in
Europace
volume
26
issue
8
article number
euae198
publisher
Oxford University Press
external identifiers
  • pmid:39056247
  • scopus:85200594499
ISSN
1099-5129
DOI
10.1093/europace/euae198
language
English
LU publication?
yes
id
c51c650a-a4e9-4a34-914f-6a53a5462ef4
date added to LUP
2024-09-10 14:39:57
date last changed
2025-07-16 19:13:51
@article{c51c650a-a4e9-4a34-914f-6a53a5462ef4,
  abstract     = {{<p>Aims Short-term ambulatory electrocardiogram (ECG) monitoring is often used to assess premature atrial complex (PAC) and premature ventricular complex (PVC) frequency, but the diagnostic reliability is unknown. The objective of this study was to study the day-to-day variability of PAC and PVC frequency. Methods We used 14-day full-disclosure mobile cardiac telemetry recordings without atrial fibrillation in 8245 US patients aged and <sup>results</sup> 17-103 years to calculate the diagnostic reliability of shorter ambulatory ECG recordings compared with 14-day averages. Over 14 days, 1853 patients had ≥500 PACs/day, 410 patients had ≥5000 PACs/day, and 197 patients had ≥10 000 PACs/day; 1640 patients had ≥500 PVCs/day, 354 patients had ≥5000 PVCs/day, and 175 patients had ≥10 000 PVCs/day. After 3 days, the estimated daily PAC frequency differed by ≥50% from the 14-day mean in 25% of patients; for PVCs, the corresponding duration was 7 days. Ten days of monitoring were needed to estimate PAC and PVC frequency within ±20% of the overall 14-day frequency in 80% of patients. For daily PAC and PVC frequencies ≥10 000, single-day estimation had a specificity of 99.3% [95% confidence interval (CI) 99.1-99.5] at a sensitivity of 76.6 (95% CI 70.1-80.4%) for PACs and a 99.6% (95% CI 99.4-99.7%) specificity at 79.4 (95% CI 72.7-85.2) sensitivity for PVCs. After 7 days, the sensitivity increased to 88.8% (95% CI 83.6-92.9) for PACs and 86.9% (95% CI 80.9-91.5%) for PVCs. <sup>Conclusion</sup> While there is substantial daily variability across most PAC and PVC levels, findings of ≥10 000 PACs or PVCs are highly specific and do not need to be confirmed with longer recordings.</p>}},
  author       = {{Måneheim, Alexandra and Lundeberg, Johan Economou and Persson, Anders P. and Edegran, Albin and Grotek-Cuprjak, Agnieszka and Juhlin, Tord and Benezet-Mazuecos, Juan and Ellenbogen, Kenneth A. and Engström, Gunnar and Healey, Jeff S. and Johnson, Linda S.}},
  issn         = {{1099-5129}},
  keywords     = {{Ambulatory electrocardiography; Diagnostic yield; Mobile cardiac telemetry; Premature atrial complex; Premature ventricular complexes}},
  language     = {{eng}},
  number       = {{8}},
  publisher    = {{Oxford University Press}},
  series       = {{Europace}},
  title        = {{Diagnostic reliability of monitoring for premature atrial and ventricular complexes}},
  url          = {{http://dx.doi.org/10.1093/europace/euae198}},
  doi          = {{10.1093/europace/euae198}},
  volume       = {{26}},
  year         = {{2024}},
}