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Consecutive, index and representative beats: obtaining reliable information despite an irregular heart rhythm
  1. Jan Minners,
  2. Nikolaus Jander
  1. Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany
  1. Correspondence to Dr Jan Minners, Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany; Jan.Minners{at}

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The number of patients presenting with the combination of atrial fibrillation (AF) and symptoms and signs of heart failure is steadily increasing. Echocardiography as the standard diagnostic tool provides comprehensive information on left ventricular systolic and diastolic function and additional underlying cardiac pathology and has gained a level 1 recommendation in the workup of patients with heart failure.1 However, the scientific basis for this recommendation is weak and—even more worrisome—non-existent, considering practical aspects regarding the assessment of ejection fraction and parameters of diastolic function in patients with AF.2 The suggestion to average a minimum of five beats in an attempt to account for varying cycle length and ventricular filling appears intuitive but whether such an approach delivers reproducible results has very little scientific underpinning, particularly for the assessment of left ventricular ejection fraction.3

Bunting et al, in their article in the current issue of Heart,4 have to be commended for tackling this knowledge gap by further investigating the ‘index beat’ approach. The …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.

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