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Longer Ambulatory ECG Monitoring Increases Identification of Clinically Significant Ectopy
Author(s) -
LORING ZAK,
HANNA PETER,
PELLEGRINI CARA N.
Publication year - 2016
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12852
Subject(s) - medicine , ambulatory ecg , ambulatory , identification (biology) , cardiology , electrocardiography , intensive care medicine , botany , biology
Background Frequent premature ventricular contractions (PVCs) can cause a reversible reduction in systolic function. Most studies use 24‐hour ambulatory electrocardiograms (AECGs) to assess PVC burden; however, PVC counts vary across 24‐hour periods. We hypothesized that extended AECG monitoring would better identify clinically significant ectopy. Methods All 14‐day AECGs performed at the San Francisco Veterans Affairs Medical Center between 2012 and 2015 (N = 694) were reviewed, and individuals with PVC counts ≥1.0% of total heartbeats were included (N = 101). Daily PVC counts and the range of these values across 24‐hour periods were assessed. Median time for these ranges to cross clinically significant thresholds (PVCs ≥ 10%, 15%, or 20% of total heartbeats) was determined. Results Median PVC burden was 2.6% of total heartbeats (interquartile range [IQR]: 1.6–5.4%) and the median range across 24‐hour periods was 3.6% (IQR: 2.0–9.1%). Individual ranges of daily PVC burden crossed thresholds of 10%, 15%, and 20% of total heartbeats in 26.7%, 16.8%, and 6.9% of patients, respectively. Median time to detecting an individual's maximum PVC burden was 6 days (IQR: 2–11 days). While 75% of those who reached the 20% threshold did so on day one of monitoring, only 53% of those reaching the 10% threshold did similarly, with a continually increasing yield throughout the 14‐day monitoring period. Conclusions PVC burden varies widely from day‐to‐day. While most patients with PVC burdens ≥20% were detected with 24 hours of monitoring, extended monitoring nearly doubled the identification of those reaching the 10% threshold.