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Published online: 2021-12-16
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Diagnostic yield is dependent on monitoring duration. Insights from a full-disclosure mobile cardiac telemetry system

Marek Dziubiński1, Natan Napiórkowski1, Olga Witkowska1, Michał A Świecak1, Agnieszka M Grotek1, Linda SB Johnson23
DOI: 10.33963/KP.a2021.0182
·
Pubmed: 34913475
Affiliations
  1. Medicalgorithmics SA, Warszawa, Poland
  2. Department of Clinical Sciences, Lund University, Malmö, Sweden
  3. Department of Imaging and Functional Studies, Skåne University Hospital, Malmö, Sweden

open access

Online first
Original article
Published online: 2021-12-16

Abstract

Background: Despite advancement of electrocardiogram (ECG) monitoring methods, the most important factor influencing diagnostic yield (DY) may still be monitoring duration. Ambulatory ECG monitoring, typically with 24–48 hours duration, is widely used, but may result in under diagnosis of rare arrhythmias.

Aims: To examine the relationship between the DY and monitoring duration in a large patient cohort, and investigate sex and age differences in the presentation of arrhythmias.

Methods: The study population consisted of 25 151 patients (57.8% women; median age, 71 (interquartile range [IQR], 64–78) years, who were examined with mobile cardiac telemetry during 2017 in the United States, using the PocketECGTM, which continuously transmits signal on a beat-to-beat basis. We investigated occurrences of atrial fibrillation at a burden of both ≤1% (atrial fibrillation [AF], ≤1%) and ≤10% (AF ≤10%), premature ventricular contractions (PVC; >10 000 per 24 hours), non-sustained ventricular tachycardias (nsVT), sustained ventricular tachycardias (VT ≥30s), atrioventricular blocks (AVB), pauses >3 seconds duration, and bradycardia  (heart rate <40 beats per minute for ≥60 seconds).

Results : The median (IQR) recording duration was 15.4 (8.2–28.2) days. The DY increased gradually with monitoring duration for all types of investigated arrhythmias; compared to DY after up to 30 days monitoring a standard 24h monitoring resulted in DY for males/females of 20%/18% for AF ≤1%, 29%/28% for AF ≤10%, 45%/40% for PVCs, 17%/11% for nsVT, 17%/11% for VT ≥30s, 49%/42 for AVB, 27%/20% for pauses, 36%/29% for bradycardia.

Conclusion: A substantial number of patients suffering from arrhythmias may remain undiagnosed due to insufficient ECG monitoring time.

Abstract

Background: Despite advancement of electrocardiogram (ECG) monitoring methods, the most important factor influencing diagnostic yield (DY) may still be monitoring duration. Ambulatory ECG monitoring, typically with 24–48 hours duration, is widely used, but may result in under diagnosis of rare arrhythmias.

Aims: To examine the relationship between the DY and monitoring duration in a large patient cohort, and investigate sex and age differences in the presentation of arrhythmias.

Methods: The study population consisted of 25 151 patients (57.8% women; median age, 71 (interquartile range [IQR], 64–78) years, who were examined with mobile cardiac telemetry during 2017 in the United States, using the PocketECGTM, which continuously transmits signal on a beat-to-beat basis. We investigated occurrences of atrial fibrillation at a burden of both ≤1% (atrial fibrillation [AF], ≤1%) and ≤10% (AF ≤10%), premature ventricular contractions (PVC; >10 000 per 24 hours), non-sustained ventricular tachycardias (nsVT), sustained ventricular tachycardias (VT ≥30s), atrioventricular blocks (AVB), pauses >3 seconds duration, and bradycardia  (heart rate <40 beats per minute for ≥60 seconds).

Results : The median (IQR) recording duration was 15.4 (8.2–28.2) days. The DY increased gradually with monitoring duration for all types of investigated arrhythmias; compared to DY after up to 30 days monitoring a standard 24h monitoring resulted in DY for males/females of 20%/18% for AF ≤1%, 29%/28% for AF ≤10%, 45%/40% for PVCs, 17%/11% for nsVT, 17%/11% for VT ≥30s, 49%/42 for AVB, 27%/20% for pauses, 36%/29% for bradycardia.

Conclusion: A substantial number of patients suffering from arrhythmias may remain undiagnosed due to insufficient ECG monitoring time.

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Keywords

ECG monitoring, diagnostic yield, mobile cardiac telemetry monitoring, arrhythmias

About this article
Title

Diagnostic yield is dependent on monitoring duration. Insights from a full-disclosure mobile cardiac telemetry system

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2021-12-16

DOI

10.33963/KP.a2021.0182

Pubmed

34913475

Keywords

ECG monitoring
diagnostic yield
mobile cardiac telemetry monitoring
arrhythmias

Authors

Marek Dziubiński
Natan Napiórkowski
Olga Witkowska
Michał A Świecak
Agnieszka M Grotek
Linda SB Johnson

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