Yield and consistency of arrhythmia detection with patch electrocardiographic monitoring: The Multi-Ethnic Study of Atherosclerosis.

BACKGROUND: Patch electrocardiographic (ECG) monitors permit extended noninvasive ambulatory monitoring. To guide use of these devices, information is needed about their performance. We sought to determine in a large general population sample the acceptability of patch ECG monitors, the yield of arrhythmia detection, and the consistency of findings in participants monitored twice. METHODS: In the Multi-Ethnic Study of Atherosclerosis, 1122 participants completed one or two monitoring episodes using the Zio Patch XT, a single-channel ECG patch monitor capable of recording for 14 days. Recordings were analyzed for atrial fibrillation (AF), atrial flutter, atrioventricular block, pauses, and supraventricular and ventricular ectopy. RESULTS: The mean(SD) age at the time of monitoring was 75(8) years, 52% were men, and 15% had a prior history of clinically-recognized AF/flutter. The median monitoring duration was 13.8 days. Among 804 participants with no prior clinical history of AF/flutter and at least 12 days of monitoring on a single device, AF/flutter was detected in 32 (4.0%); in 38% of these, AF/flutter was first detected during days 3 through 12 of monitoring. In participants monitored twice, findings from the two devices showed excellent agreement for supraventricular and ventricular ectopic beats per hour, but only fair agreement for high-grade atrioventricular block and pauses of >3 s duration. CONCLUSIONS: In a general population of older individuals, new diagnoses of AF/flutter were made in 4.0% of participants without a prior history. A single monitoring episode accurately estimated rates of supraventricular and ventricular ectopy.

The Relationship Between Premature Ventricular Contractions and Lifestyle-Related Habits among the Japanese Working Population (FUJITSU Cardiovascular and Respiratory Observational Study-1; FACT-1).

BACKGROUND: Premature ventricular contractions (PVCs) are often found in healthy workers at medical checkups. In this study, we aimed to investigate the frequency of PVCs recorded during medical checkups in Japanese office workers without heart disease or other known contributing factors. METHODS: Participants in this study were 17,641 office workers, who underwent an electrocardiogram examination during a regular medical checkup between April 1 2015 and March 31 2016 and had no known heart disease. The frequency of PVCs was recorded. Participants with PVCs were included in the PVC group and a control group of participants without PVCs was set in a nested case-control study to calculate the rate of complications for lifestyle-related diseases and the risk rate of PVCs for lifestyle-related habits. RESULTS: Within the participant group, PVCs were observed in 303 individuals (1.7%). When compared with the control group, the occurrence of regularly drinking alcohol (P=0.009) and insomnia (P=0.006) were significantly higher in the PVC group. Factors related to the onset of PVCs were examined using univariate analysis. The odds ratio (OR) was 1.731 in participants who regularly drank alcohol (95% CI: 1.146-2.633, P=0.009) when compared with participants who did not regularly drink alcohol, and 1.569 in participants with insomnia (95% CI: 1.023-2.422, P=0.040) when compared with participants without insomnia. CONCLUSION: The frequency of PVCs recorded at regular medical checkups in Japanese office workers without heart disease was 1.7%. Within our group of participants, the factors related to the onset of PVCs were a history of regularly drinking alcohol and sleep disorders.

Prevalence of premature ventricular contractions in a population of African American and white men and women: the Atherosclerosis Risk in Communities (ARIC) study.

BACKGROUND: The distribution or the causes of premature ventricular contractions (PVCs) in diverse populations are not fully known. We describe the prevalence of PVCs on a 2-minute electrocardiogram (ECG) in adults to determine whether hypertension has an important association with such PVCs. METHODS: A cross-sectional analysis of the 15,792 individuals (aged 45-65 years) from the four US communities participating at visit 1 of the Atherosclerosis Risk In Communities (ARIC) study was performed. Multiple logistic regression was used to determine the association of PVCs with potential causal predictors of PVCs. RESULTS: Based on a 2-minute ECG, PVCs are present in >6% of middle-aged adults. Increasing age, the presence of heart disease, faster sinus rates, African American ethnicity, male sex, lower educational attainment, and lower serum magnesium or potassium levels are directly related to PVC prevalence. Independently of these factors, hypertension is associated with a 23% increase in the prevalence of PVCs. CONCLUSIONS: The prevalence of PVCs on a 2-minute ECG differs by age, ethnicity, and sex and is associated with hypertension, heart disease, faster sinus rates, electrolyte abnormalities, and lower educational attainment. Hypertension is likely to be a major cause of PVCs in adults.

Association of ventricular premature complexes with electrocardiographic-estimated left ventricular mass in a population of African-American and white men and women (The Atherosclerosis Risk in Communities.

Increased left ventricular (LV) mass is often found in adults and is a powerful predictor of cardiovascular mortality. To test the hypothesis that an electrocardiographic estimate of LV mass--the Cornell voltage--is associated with ventricular premature complexes (VPCs) in free-living adults, a cross-sectional analysis of the predictors of VPCs on a 2-minute rhythm strip in a population-based sample of 13,606 middle-aged, African-American and white men and women from 4 US communities in the Atherosclerosis Risk in Communities Study baseline examinations was performed. In adults without known coronary artery disease, the prevalence of VPCs increases monotonically with increasd Cornell voltages within ethnicity and gender groups. Independent of systemic hypertension, serum electrolytes, age, heart rate, educational attainment, gender, and ethnicity, a millivolt increase in Cornell voltage was associated with a 20% to 30% increase in the prevalence odds ratio of VPCs on the 2-minute electrocardiogram. Thus, Cornell voltage is associated with VPCs on a 2-minute electrocardiogram. The association is consistent in African-Americans, whites, men, and women.

Phenotypic analysis of arrhythmogenic cardiomyopathy in the Hutterite population: role of electrocardiogram in identifying high-risk desmocollin-2 carriers.

BACKGROUND: The p.Gln554X mutation in desmocollin-2 (DSC2) is prevalent in ≈10% of the Hutterite population. While the homozygous mutation causes severe biventricular arrhythmogenic right ventricular cardiomyopathy, the phenotypic features and prognosis of heterozygotes remain incompletely understood. METHODS AND RESULTS: Eleven homozygotes (mean age 32±8 years, 45% female), 28 heterozygotes (mean age 40±15 years, 50% female), and 22 mutation-negatives (mean age 43±17 years, 41% female) were examined. Diagnostic testing was performed as per the arrhythmogenic right ventricular cardiomyopathy modified Task Force Criteria. Inverted T waves in the right precordial leads on ECG were seen in all homozygotes but not in their counterparts (P<0.001). Homozygotes had higher median daily premature ventricular complex burden than did heterozygotes or mutation-negatives (1407 [IQR 1080 to 2936] versus 2 [IQR 0 to 6] versus 6 [IQR 0 to 214], P=0.0002). Ventricular tachycardia was observed in 60% of homozygotes but in none of the remaining individuals (P<0.001). On cardiac magnetic resonance imaging, homozygotes had significantly larger indexed end-diastolic volumes (right ventricular: 122±24 versus 83±17 versus 83±12 mL/m(2), P<0.0001; left ventricular: 93±18 versus 76±13 versus 80±11 mL/m(2), P=0.0124) and lower ejection fraction values compared with heterozygotes and mutation-negatives (right ventricular ejection fraction: 41±9% versus 59±9% versus 61±6%, P<0.0001; left ventricular ejection fraction: 53±8% versus 65±5% versus 64±5%, P<0.0001). Most affected individuals lacked right ventricular wall motion abnormalities. Thus, few met cardiac magnetic resonance imaging task force criteria. CONCLUSIONS: The ECG reliably identifies homozygous p.Gln554X carriers and may be useful as an initial step in the screening of high-risk Hutterites. The cardiac phenotype of heterozygotes appears benign, but further prospective follow-up of their arrhythmic risk is needed.

Depressive symptoms and risk factors in Chinese patients with premature ventricular contractions without structural heart disease.

HYPOTHESIS: Our objective was to study depressive symptoms and potential risk factors in Chinese persons with premature ventricular contractions (PVCs) without structural heart disease. METHODS: The Zung self-rating depression scale (ZSDS) was used to assess depressive symptoms. Correlations between depressive symptoms and sociodemographic and medical factors were analyzed by logistic regression. BACKGROUND: Prevalence of depressive symptoms in coronary heart disease (CHD) is higher that in the general population and those for the majority of other chronic symptoms in patients with premature ventricular contractions (PUCS). RESULTS: Of 1,144 patients with PVCs (488 males, 656 females), age 51 +/- 23 years, disease duration 1 mo - 23 y, a total of 309 (27%) patients were categorized as having depressive symptoms. Depressive symptoms increased with age, income, education level, nationality, PVC count/24h, society support, and settlement type (p < 0.05). Univariate logistic regression showed that being female, level of education, age, settlement type, and PVC count/24h significantly correlated with depressive symptoms (p < 0.05). Multivariate logistic regression indicated that 5 variables-female sex, education level, settlement type, age, and PVC count/24h significantly and independently related with depressive symptoms (p < 0.05). CONCLUSIONS: In the Chinese population, depressive symptoms in subjects with PVCs were frequent. The village settlement type, female sex, age, PVC count/24h, and education level were independent risk factors for depressive symptoms. Further research on the relationship between PVCs and depressive symptoms in China is necessary.