Vol 80, No 1 (2022)
Original article
Published online: 2021-12-16

open access

Page views 5870
Article views/downloads 888
Get Citation

Connect on Social Media

Connect on Social Media

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
Pubmed: 34913475
Kardiol Pol 2022;80(1):49-55.

Abstract

Background: Despite the 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 underdiagnosis of rare arrhythmias.
Aims: This study aimed 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 [interquartile range, IQR], 71 [64–78] years), who were examined with mobile cardiac telemetry during 2017 in the United States, using the PocketECGTM that continuously transmits a signal on a beat-to-beat basis. We investigated the occurrence 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 ≥30 seconds), atrioventricular blocks (AVB), pauses of >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 of monitoring, a standard 24 hours 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 ≥30 seconds, 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.

References

  1. Thiruganasambandamoorthy V, Rowe B, Sivilotti M, et al. Duration of electrocardiographic monitoring of emergency department patients with syncope. Circulation. 2019; 139(11): 1396–1406.
  2. Hsia B, Greige N, Patel S, et al. Determining the optimal duration for premature ventricular contraction monitoring. Heart Rhythm. 2020; 17(12): 2119–2125.
  3. Cheung CC, Kerr CR, Krahn AD. Comparing 14-day adhesive patch with 24-h Holter monitoring. Future Cardiol. 2014; 10(3): 319–322.
  4. Hayıroğlu Mİ, Çinier G, Yüksel G, et al. Effect of a mobile application and smart devices on heart rate variability in diabetic patients with high cardiovascular risk: A sub-study of the LIGHT randomized clinical trial. Kardiol Pol. 2021; 79(11): 1239–1244.
  5. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2018; 15(10): e190–e252.
  6. Dziubiński M. PocketECG: a new continuous and real-time ambulatory arrhythmia diagnostic method. Cardiol J. 2011; 18(4): 454–460.
  7. U.S. Food and Drug Administration. Premarket Notification. Available online: www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=K090037. [Access: November 10, 2020].
  8. Farzam K, Richards JR. Premature ventricular contraction. Treasure Island, FL, USA, StatPearls Publishing 2021.
  9. Koester C, Ibrahim AM, Cancel M, et al. The ubiquitous premature ventricular complex. Cureus. 2020; 12(1): e6585.
  10. Ventricular tachycardia. Treasure Island, FL, USA, StatPearls Publishing 2020.
  11. Katritsis DG, Zareba W, Camm AJ. Nonsustained ventricular tachycardia. J Am Coll Cardiol. 2012; 60(20): 1993–2004.
  12. Kashou AH, Goyal A, Nguyenet T, et al. Atrioventricular Block. Treasure Island, FL, USA, StatPearls Publishing 2017.
  13. Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2019; 140(8): e382–e482.
  14. Lifelines. Available online: https://lifelines.readthedocs.io/en/latest/index.html. [Access: December 16, 2021].
  15. Rich JT, Neely JG, Paniello RC, et al. A practical guide to understanding Kaplan-Meier curves. Otolaryngol Head Neck Surg. 2010; 143(3): 331–336.
  16. Miettinen OS. Survival analysis: up from Kaplan-Meier-Greenwood. Eur J Epidemiol. 2008; 23(9): 585–592.
  17. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966; 50(3): 163–170.
  18. Bernal O, Moro C. Cardiac arrhythmias in women. Rev Esp Cardiol (Engl Ed). 2006; 59(6): 609–618.