PDF(Pubmed)
Abstract：
OBJECTIVE: 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.
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.
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.
摘要：
背景：短期动态心电图监测通常用于评估早发心房复合体（PAC）和早发心室复合体（PVC）的频率，但诊断的可靠性是未知的。
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.
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.
