Premature atrial and ventricular contractions detected on wearable-format electrocardiograms and prediction of cardiovascular events

Michele Orini; Stefan van Duijvenboden; William J Young; Julia Ramírez; Aled R Jones; Andrew Tinker; Patricia B Munroe; Pier D Lambiase

doi:10.1093/ehjdh/ztad007

Premature atrial and ventricular contractions detected on wearable-format electrocardiograms and prediction of cardiovascular events

Eur Heart J Digit Health. 2023 Feb 3;4(2):112-118. doi: 10.1093/ehjdh/ztad007. eCollection 2023 Mar.

Authors

Michele Orini^{1

2

3}, Stefan van Duijvenboden^{1

4

5}, William J Young^{3

4}, Julia Ramírez^{4

6}, Aled R Jones^{3

4}, Andrew Tinker⁴, Patricia B Munroe⁴, Pier D Lambiase^{1

3}

Affiliations

¹ Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK.
² MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK.
³ Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
⁴ Clinical Pharmacology and Precision Medicine, Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
⁵ Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
⁶ Aragon Institute of Engineering Research, University of Zaragoza and Centro de Investigación Biomédica en Red, Bioingeniería, Biomateriales y Nanotecnología Zaragoza, C/ de Mariano Esquillor Gómez, Zaragoza 50018, Spain.

Abstract

Aims: Wearable devices are transforming the electrocardiogram (ECG) into a ubiquitous medical test. This study assesses the association between premature ventricular and atrial contractions (PVCs and PACs) detected on wearable-format ECGs (15 s single lead) and cardiovascular outcomes in individuals without cardiovascular disease (CVD).

Methods and results: Premature atrial contractions and PVCs were identified in 15 s single-lead ECGs from N = 54 016 UK Biobank participants (median age, interquartile range, age 58, 50-63 years, 54% female). Cox regression models adjusted for traditional risk factors were used to determine associations with atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI), stroke, life-threatening ventricular arrhythmias (LTVAs), and mortality over a period of 11.5 (11.4-11.7) years. The strongest associations were found between PVCs (prevalence 2.2%) and HF (hazard ratio, HR, 95% confidence interval = 2.09, 1.58-2.78) and between PACs (prevalence 1.9%) and AF (HR = 2.52, 2.11-3.01), with shorter prematurity further increasing risk. Premature ventricular contractions and PACs were also associated with LTVA (P < 0.05). Associations with MI, stroke, and mortality were significant only in unadjusted models. In a separate UK Biobank sub-study sample [UKB-2, N = 29,324, age 64, 58-60 years, 54% female, follow-up 3.5 (2.6-4.8) years] used for independent validation, after adjusting for risk factors, PACs were associated with AF (HR = 1.80, 1.12-2.89) and PVCs with HF (HR = 2.32, 1.28-4.22).

Conclusion: In middle-aged individuals without CVD, premature contractions identified in 15 s single-lead ECGs are strongly associated with an increased risk of AF and HF. These data warrant further investigation to assess the role of wearable ECGs for early cardiovascular risk stratification.

Keywords: Arrhythmias; Atrial fibrillation; Heart failure; Premature contractions; Wearable ECG.

Grants and funding

MR/N025083/1/MRC_/Medical Research Council/United Kingdom