How reliable are single day electrocardiogram measurements to detect excessive supraventricular ectopic activity?

Abstract

Abstract Background Excessive Supraventricular Activity (ESVEA) is widely recognized as a significant risk marker for incident atrial fibrillation, but the diagnostic reliability of ESVEA measured by 24-hour electrocardiogram (ECG) is unknown. Objectives To study the variability of ESVEA over 14 days using mobile cardiac telemetry (MCT). Methods We included US patients aged 17-100 years with ≥14 full days of ambulatory full-disclosure ECG using an MCT device during 2017, without atrial fibrillation during any of the recording days. ESVEA was defined as the presence of ≥720 premature atrial complexes and/or a ≥20 beat long supraventricular tachycardia, and calculated for each recording day. Results The study population consisted of 9,899 patients (median age 70 (interquartile range 59-77) years, 57% female). ESVEA was very common: 45% (n= 4,453) had ESVEA on at least one day. Of the patients with ESVEA, it occurred on one day only in 28% and on all registered days in 18%. The median number of ESVEA positive days was 4 (IQR 1-12). On the first monitoring day, 20% were ESVEA positive, resulting in a sensitivity of 44.64% and a negative predictive value of 68.84% of a single day measurement of ESVEA. Conclusions ESVEA occurs in almost half of an MCT population, but less than half of the patients with any occurrence of ESVEA are detected on the first monitored day. Reliable diagnosis of supraventricular ectopy requires longer monitoring durations.