Repeatability of ectopic beats from 48-hr ambulatory electrocardiography: The Atherosclerosis Risk in Communities (ARIC) Study

Ann Noninvasive Electrocardiol. 2017 Jul;22(4):e12426. doi: 10.1111/anec.12426. Epub 2017 Jan 6.


Background: The purpose of this study was to characterize the repeatability of ectopic beats, defined by premature atrial contractions (PACs) and premature ventricular contractions (PVCs), on ambulatory electrocardiogram (aECG) monitoring and evaluate the effect of length of aECG monitoring on the repeatability estimates.

Methods: This analysis includes 95 randomly selected participants from the Atherosclerosis Risk in Communities Study (ARIC; 2011-2013). The participants wore a Holter monitor for two, 48-hr periods separated by a mean of 38 days following an identical, standardized protocol. We divided each 48-hr recording into 3-, 6-, 12-, and 24-hr recording periods and calculated intraclass correlation coefficients (ICCs) for PACs and PVCs and also as a percentage of the corresponding total of recorded beats per hour among these periods.

Results: All participants had ≥1 PAC during the 48-hr recordings, and only two participants had no PVCs. ICCs were >0.83 for all indices and recording lengths ≥12 hrs. ICCs were intermediate for 6-hr recordings (range 0.80-0.83) and lower for 3-hr recordings (range 0.74-0.80). The ratio of the between- to within-participant variation increased with recording length.

Conclusion: Repeatability of PACs and PVCs was excellent for recording lengths of 6-24 hr and fair for 3 hr. Repeatability varies over shorter duration recordings within the 48-hr recording period, and thus the present results have implications for detection algorithms for ectopic beats and can facilitate epidemiologic and clinical applications in which knowledge of measurement variability and misclassification are needed.

Keywords: Holter; premature atrial contractions; premature ventricular contractions; supraventricular ectopic beats; ventricular ectopic beats.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Atherosclerosis / complications*
  • Atrial Premature Complexes / complications
  • Atrial Premature Complexes / diagnosis*
  • Atrial Premature Complexes / physiopathology
  • Cohort Studies
  • Electrocardiography, Ambulatory / methods
  • Electrocardiography, Ambulatory / statistics & numerical data*
  • Female
  • Geriatric Assessment / methods
  • Geriatric Assessment / statistics & numerical data*
  • Health Surveys / methods
  • Health Surveys / statistics & numerical data*
  • Humans
  • Independent Living
  • Longitudinal Studies
  • Male
  • Reproducibility of Results
  • Risk
  • Risk Factors
  • Time Factors
  • Ventricular Premature Complexes / complications
  • Ventricular Premature Complexes / diagnosis*
  • Ventricular Premature Complexes / physiopathology