Comparison of methods for editing of ectopic beats in measurements of short-term non-linear heart rate dynamics

Non-linear heart rate (HR) dynamics characterizes the fractal properties and complexity of the variations in HR. Ventricular and supraventricular ectopic beats might introduce a mathematical artefact to the analyses on sinus rhythm. We therefore evaluated the effects of different editing practices for ectopic beats such that 753 40-min ECG recordings were (i) not edited for the ectopic beats, or the ectopic beats were edited with (ii) an interpolation or with (iii) a deletion method before the analyses of non-linear HR dynamics. The non-linear HR dynamics analyses included detrended fluctuation analysis (DFA), approximate entropy, symbolic dynamics (SymDyn), fractal dimension and return map (RM). We found that the short-term scaling exponent (alpha1) of DFA, forbidden words of SymDyn and RM were sensitive measurements to the ectopic beats and there were strong correlations between these measurements and the number of ectopic beats. In addition, the unedited ectopic beats significantly lowered the stability of these measurements. However, the editing either with interpolation or deletion method corrected the measurements for the bias caused by the ectopic beats. On the contrary, the entropy measurements were not as sensitive to the ectopic beats. In conclusion, the ectopic beats affect the non-linear HR dynamics of sinus rhythm differently, causing a more marked bias in fractal than in complexity measurements of non-linear HR dynamics. This erroneous effect of ectopic beats can be corrected with a proper editing of these measurements. Therefore, there is an obvious need for standardized editing practices for ectopic beats before the analysis of non-linear HR dynamics.