Reliability of resting heart rate measurements in atrial fibrillation.

Authors

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

Published in

Journal of electrocardiology. Volume 98. Pages 154408. Jul 18, 2026. Epub Jul 18, 2026.

Abstract

Heart rate (HR) control in atrial fibrillation (AF) is commonly guided by resting HR measurements, usually with 12‑lead ECG or in-office pulse palpation.
We aimed to assess the reliability of resting HR measurements in AF patients with long-term ambulatory ECG and activity monitoring.
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 (≤20 per individual/day) were collected as 10-s daytime (8 am to 8 pm) measurements after ≥10 min of rest. These samples were compared to each individual's mean daytime resting HR.
In 832 patients (median age 77 (interquartile range (IQR) 69-83) years, 42% women) with a median registration duration of 13 days (IQR 7-22), the population mean daytime resting HR was 85 (±15) beats per minute (bpm). A single resting HR differed from the mean daytime resting HR by a mean of ±10.4% (IQR 3.6-14.4%). When the mean daytime resting HR was ≥110 bpm, 29% of resting HR samples were < 110 bpm, and when the mean daytime resting HR was 80-109 bpm,11% of samples were ≥ 110 bpm. Resting HR measurement variability decreased to 5.3% (IQR 1.9-7.5%) when four resting HR samples were averaged.
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.

PMID:
42497467
Bibliographic data and abstract were imported from PubMed on 25 Jul 2026.

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