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Reliability of resting heart rate measurements in atrial fibrillation.

Anders P Persson·William F McIntyre·Taya Glotzer·Jason G Andrade·David Conen·Artur Fedorowski·Alexandra Måneheim·Johan Economou Lundeberg·Tord Juhlin·Albin Edegran·Agnieszka Grotek-Cuprjak·Jeff S Healey·Gunnar Engström·Michiel Rienstra·Linda S Johnson
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Abstract

BACKGROUND: Heart rate (HR) control in atrial fibrillation (AF) is commonly guided by resting HR measurements, usually with 12&#x2011;lead ECG or in-office pulse palpation. OBJECTIVES: We aimed to assess the reliability of resting HR measurements in AF patients with long-term ambulatory ECG and activity monitoring. METHODS: We included patients who had recorded a full-disclosure ambulatory ECG with a mobile cardiac telemetry device equipped with an accelerometer (PocketECG, MEDICALgorithmics, Poland), with at least 95% AF. Resting HR samples (&#x2264;20 per individual/day) were collected as 10-s daytime (8&#xa0;am to 8&#xa0;pm) measurements after &#x2265;10&#xa0;min of rest. These samples were compared to each individual's mean daytime resting HR. RESULTS: In 832 patients (median age 77 (interquartile range (IQR) 69-83) years, 42% women) with a median registration duration of 13&#xa0;days (IQR 7-22), the population mean daytime resting HR was 85 (&#xb1;15) beats per minute (bpm). A single resting HR differed from the mean daytime resting HR by a mean of &#xb1;10.4% (IQR 3.6-14.4%). When the mean daytime resting HR was &#x2265;110&#xa0;bpm, 29% of resting HR samples were&#xa0;<&#xa0;110&#xa0;bpm, and when the mean daytime resting HR was 80-109&#xa0;bpm,11% of samples were&#xa0;&#x2265;&#xa0;110&#xa0;bpm. Resting HR measurement variability decreased to 5.3% (IQR 1.9-7.5%) when four resting HR samples were averaged. CONCLUSION: In patients with AF, a single resting HR measurement often differs substantially from the mean daytime resting HR. When a precise measurement is clinically relevant, repeated resting HR sampling or ambulatory monitoring can address this measurement imprecision.

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HumansAtrial FibrillationFemaleReproducibility of ResultsMaleHeart RateElectrocardiography, AmbulatoryAgedAged, 80 and overRestSensitivity and SpecificityHeart Rate DeterminationTelemetryAmbulatory ECGAtrial fibrillationECGElectrocardiogramRate controlResting heart rateJournal Article

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Anders P Persson, William F McIntyre, Taya Glotzer, Jason G Andrade, David Conen, Artur Fedorowski, Alexandra M&#xe5;neheim, Johan Economou Lundeberg, Tord Juhlin, Albin Edegran, Agnieszka Grotek-Cuprjak, Jeff S Healey, Gunnar Engstr&#xf6;m, Michiel Rienstra, Linda S Johnson. 2026-07-18. Reliability of resting heart rate measurements in atrial fibrillation.. https://doi.org/10.1016/j.jelectrocard.2026.154408

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