Nocturnal Cardiac Arrhythmia Scoring in Heart Failure with Reduced Ejection Fraction

Arrhythmia, PVC, premature ventricular complex, EKG, ECG
Arrhythmia, PVC, premature ventricular complex, EKG, ECG
A study was done to develop a way to detect nocturnal cardiac arrhythmias accurately in patients with HFrEF via single-lead electrocardiography during polysomnography.

Researchers can accurately score nocturnal cardiac arrhythmias (NCA) with a single-lead electrocardiogram (ECG), according to research published in the International Journal of Cardiology Heart and Vasculature.

NCAs in patients with heart failure with reduced ejection fraction (HFrEF) may be instigated by sleep disordered breathing (SDB), and an ancillary study of the Effect of Adaptive Servo Ventilation on Survival and Hospital Admissions in Heart Failure (ADVENT-HF; identifier: NCT01128816) trial will test whether peak-flow-triggered adaptive servoventilation (ASVpf) will reduce NCA among these patients. Researchers sought to develop an accurate detection method for NCA recorded via electrocardiography and to assess the subsequent agreement of interobservers.

To accomplish this, they conducted a developmental study and analysis that included 62 patients from the ADVENT-HF trial and specific training of investigators, enhancement of standardized technical quality, semi-automated NCA-scoring via Holter-ECG software that conforms to guidelines, and the initiation of an arrhythmia adjudication committee. The 2 independent investigators who analyzed the ECG were compared for agreement on premature atrial complexes per hour (PAC/h), premature ventricular complexes per hour (PVC/h), and any other NCA in these patients in order to assess interobserver agreement.

The intraclass correlation coefficient for PAC/h was 0.99 (95% CI, 0.97–0.99) and 0.99 (95% CI, 0.99–0.99) for PVC/h. For other NCA, no relevant difference in interobserver classification was found. The 2 independent investigators found no sustained ventricular tachycardia, and they found similar results for atrial fibrillation (10% vs 11%) and for non-sustained ventricular tachycardia (18% vs 19%).

Study limitations include ECG recording solely in 1 night, so no daytime cardiac arrhythmias were assessed, uncertainty about results being applied to other Holter-ECG software, and selection bias. Also, some ECGs were excluded from analysis, and differentiating PAC and PVC is sometimes more difficult with single-lead ECG monitoring than 3-lead ECG Holter monitoring.

Researchers concluded that their methods are, “very reliable for scoring NCAs and are adequate to apply for the entire PSG data set of the ADVENT-HF trial.”

Disclosure: This research was supported by Philips Respironics. Please see the original reference for a full list of disclosures.


Horvath CM, Fisser C, Douglas Bradley T, et al. Methodology for the nocturnal cardiac arrhythmia ancillary study of the ADVENT-HF trial in patients with heart failure with reduced ejection fraction and sleep-disordered breathing. Int J Cardiol Heart Vasc. Published online May 21, 2022. doi:10.1016/j.ijcha.2022.101057