Key result
7-day ECG monitoring yields up to ~6-fold higher sensitivity for detecting HRV abnormalities than 24-hour recording.
Why the study?
The analysis of HRV and HR dynamics has been standardized to 24-hour Holter ECG, but the effects of longer-term continuous ECG monitoring on their assessment were unclear.
Does 7-day continuous ECG monitoring improve the detection of abnormalities in heart rate variability and dynamics compared to 24-hour ECG in outpatients with sinus rhythm?
Observational (n=107)
Does 7-day continuous ECG monitoring improve the detection of abnormalities in heart rate variability and dynamics compared to 24-hour ECG in outpatients with sinus rhythm?
Effect estimate: 2.3- to 6.5-fold increase in sensitivity
7-day continuous ECG monitoring significantly increases the sensitivity for detecting both persistent and transient abnormalities in heart rate variability and dynamics compared to standard 24-hour monitoring.
May support extended monitoring for HRV assessment in outpatients; hypothesis-generating and leaves open impact on outcomes or practice change.
BACKGROUND: The analysis of heart rate variability (HRV) and heart rate (HR) dynamics by Holter ECG has been standardized to 24 hs, but longer-term continuous ECG monitoring has become available in clinical practice. We investigated the effects of long-term ECG on the assessment of HRV and HR dynamics. METHODS: Intraweek variations in HRV and HR dynamics were analyzed in 107 outpatients with sinus rhythm. ECG was recorded continuously for 7 days with a flexible, codeless, waterproof sensor attached on the upper chest wall. Data were divided into seven 24-h segments, and standard time- and frequency-domain HRV and nonlinear HR dynamics indices were computed for each segment. RESULTS: The intraweek coefficients of variance of HRV and HR dynamics indices ranged from 2.9% to 26.0% and were smaller for frequency-domain than for time-domain indices, and for indices reflecting slower HR fluctuations than faster fluctuations. The indices with large variance often showed transient abnormalities from day to day over 7 days, reducing the positive predictive accuracy of the 24-h ECG for detecting persistent abnormalities over 7 days. Conversely, 7-day ECG provided 2.3- to 6.5-fold increase in sensitivity to detect persistent plus transient abnormalities compared with 24-h ECG. It detected an average of 1.74 to 2.91 times as many abnormal indices as 24-h ECG. CONCLUSIONS: Long-term ECG monitoring increases the accuracy and sensitivity of detecting persistent and transient abnormalities in HRV and HR dynamics and allows discrimination between the two types of abnormalities. Whether this discrimination improves risk stratification deserves further studies.
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Hayano et al. (2021) conducted an observational in outpatients with sinus rhythm (n=107). 7-day continuous ECG monitoring vs. 24-h ECG monitoring was evaluated on Detection of persistent plus transient abnormalities in HRV and HR dynamics (2.3- to 6.5-fold increase in sensitivity). 7-day continuous ECG monitoring provided a 2.3- to 6.5-fold increase in sensitivity to detect persistent and transient abnormalities in heart rate variability compared with 24-hour ECG.
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