RESULTS: We used 14-day full-disclosure mobile cardiac telemetry recordings without atrial fibrillation in 8245 US patients aged 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.
CONCLUSIONS: 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.
目的:研究PAC和PVC频率的日常变异性。
方法:我们在8,245名年龄在17-103岁的美国患者中使用了14天的完整公开移动心脏遥测记录,以计算与14天平均值相比较短的动态心电图记录的诊断可靠性。
结果:超过14天,1853例患者有≥500PACs/天,410例患者有≥5000PACs/天,197例患者有≥10,000个PACs/天;1640例患者有≥500个PVC/天,354例患者有≥5,000个PVC/天,175例患者有≥10,000个PVC/天。3天后,25%的患者的估计每日PAC频率与14天平均值相差≥50%;对于PVC,相应的持续时间为7天。在80%的患者中,需要10天的监测来估计PAC和PVC频率在总的14天频率的±20%内。对于每日PAC和PVC频率≥10,000,单日估计的特异性为99.3%(95CI99.1-99.5),对PAC的敏感性为76.6(95CI70.1-80.4%),对PVC的敏感性为99.6%(95CI99.4-99.7%)。7天后,PAC的敏感性增加到88.8%(95CI83.6-92.9),PVC的敏感性增加到86.9%(95CI80.9-91.5%)。
结论:虽然大多数PAC和PVC水平的每日变化很大,≥10,000个PAC或PVC的发现具有高度特异性,不需要通过更长的记录进行确认.