Increasing averaging beats improves the test accuracy on Holter‐based late potentials in patients with myocardial infarction

BACKGROUND: The prevalence of Holter‐based late potentials (H‐LPs) in cases of fatal cardiac events has increased. Although the noise level of H‐LP is higher than that of conventional real‐time late potential (LP) recording, a procedure to reduce the noise severity in H‐LP by increasing the averaging beats has not been investigated. METHODS: We enrolled 104 patients with post‐myocardial infarction (MI) and 86 control participants. Among the patients, 30 reported sustained ventricular tachycardia (VT), and the remaining 74 had unrecorded VT. H‐LPs were measured twice in all groups to evaluate the efficacy of increasing the averaging beats for H‐LPs. Thereafter, the average of LP was calculated at 250 (default setting), 300, 400, 500, 600, 700, and 800 beats. RESULTS: Across all three groups (MI‐VT group, MI non‐VT group, and control group), the noise levels significantly decreased in consonance with the increase in averaging beats. In the MI‐VT group, the H‐LP positive rate considerably increased with the increase in the averaging beats from 250 to 800 both at night and daytime. In the MI‐VT group, the LP parameters significantly deteriorated, which led to a positive judgment corresponding to the increment of the averaged night and day beats. The H‐LP positive rates were unchanged in the MI non‐VT and control groups, while the LP parameters remained consistent, despite the increased averaging beats in the MI non‐VT and control groups. CONCLUSION: Increasing the calculated averaging beats in H‐LPs can improve the sensitivity of predicting fatal cardiac events in patients with MI.