scholarly journals LONG-TERM AMBULATORY ECG MONITORING AN ESSENTIAL DIAGNOSTIC TOOL FOR CURRENT TIMES

2022 ◽  
Vol 54 (4) ◽  
pp. 380-382
Author(s):  
Pir Sheeraz Ali ◽  
Syed Haseeb Raza ◽  
Sarah Mansoor
Keyword(s):  
Atrial Fibrillation ◽  
Holter Monitoring ◽  
Well Being ◽  
Control Treatment ◽  
Smart Devices ◽  
Daily Routine ◽  
Ecg Monitoring ◽  
Congenital Diseases ◽  
Ambulatory Ecg ◽  
Obstructive Sleep

Ambulatory ECG (AECG) monitoring with diary correlation of symptoms has been proven to provide significant diagnostic, therapeutic and prognostic benefit with an arrhythmic cause of symptoms. Arrhythmias can range from premature atrial and ventricular complexes (APCs/ PVCs usually benign), to Atrial and Ventricular Fibrillation which causes significant morbidity and mortality. Symptoms such as palpitations, shortness of breath, chest pain and syncope are common during arrhythmias and their frequency determines the choice of investigation needed to diagnose the arrythmia. Arrhythmias can be a manifestation of many cardiac and non-cardiac diseases. These also include congenital diseases and are often missed due to inadequate monitoring. Since most arrhythmias are intermittent they are more likely to be detected during extended ECG monitoring. Other uses of ambulatory ECG devices include ST segment analysis, heart rate variability, signal averaged ECGs, diurnal QT and QTc analysis (including patients with long QT) (1) obstructive sleep apnea and vectorcardiography (2). These factors have been shown to have relation to significant cardiovascular diseases aiding the diagnosis of various arrhythmias. Syncope although mostly benign, could potentially be a consequence of a life-threatening arrhythmia in up to 20% patients(3). Nonetheless syncope poses a significant cause of disturbance in a patients’ life and definitive diagnosis is necessary to ensure patients well-being. ESC Guidelines on Syncope (2018) recommend further testing with AECG via Holter monitoring, wearable patch recorder, external and internal loop recorders etc. depending on the frequency after initial examination is negative for a definite cause. Atrial Fibrillation (AF) increases risk of stroke more than five times. Atrial Fibrillation diagnosed after stroke is an important hallmark of recurrent stroke risk. (7) Many studies have demonstrated post stroke AECG increases the chances of detecting AF (15% vs 5%) when compared to standard monitoring. An increase incidence in atrial arrythmias (atrial high rate episodes AHRE) has been seen in patients with Permanent Pacemakers which should be documented by AECG to be treated accordingly.(4). Uses can be prognostic if rate was to be monitored in AF to assess efficacy of rate control treatment and offer adequate anticoagulation according to the 2020 ESC atrial fibrillation guidelines. (8) Some limitations of twenty-four hours Holter monitoring have recently been overcome by improvements in hardware and software technology including adhesive patches and wireless telemetry. Newer adhesive patches are softer, waterproof and electrode free monitors which offer unprecedented mobility and ease of carrying out daily routine by the patient. They operate as either recorders or wireless streaming devices (5). These devices were safe and effective during the pandemic even when delivered home through mail to critically ill patients.(6) The advent of smart phones has added endless potential for recording through wireless Bluetooth transmission. Smart devices like the OMSHIRTtm have the added advantage of being comfortable to wear. Newer devices for example Cardiostat has been shown to offer equal quality tracings when compared to standard Holter monitoring, often up to the 99% sensitivity and specificity through better designed R wave (QRS) detection algorithms(7) (8)Studies have shown these newer devices to be easily operable and can even be mailed to patients homes for self-attachment with an equal efficacy to hospital applied machine (6). Many studies have shown a preference over intra cardiac monitors (ICM) due to these above mentioned advantages (9). The effectiveness of even longer recordings through Implantable Loop Recorder has also been satisfactory when following patients after Ablation therapy leading to practice updating guideline changes in rhythm management(10). A recent review article summarized  that although physicians in the US  had knowledge of how and when to offer  monitoring devices based on the frequency of symptoms, they were often seen prescribing Holter monitoring due to familiarity. Data also showed that in case the initial investigation was inconclusive, the physician would still repeat the same investigation(3). In a country like Pakistan where there are limited resources, diagnosis and management of arrythmias still has a long way to go. This article sheds light on the need of utilizing the recommended available devices.

Ambulatory ECG Monitoring in Atrial Fibrillation Management

2013 ◽  
Vol 56 (2) ◽  
pp. 143-152 ◽  
Author(s):  
Spencer Z. Rosero ◽  
Valentina Kutyifa ◽  
Brian Olshansky ◽  
Wojciech Zareba
Keyword(s):  
Atrial Fibrillation ◽  
Ecg Monitoring ◽  
Ambulatory Ecg ◽  
Ambulatory Ecg Monitoring

Frequent premature atrial complexes and risk of concurrent atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L.S.B Johnson ◽  
N Napiorkowski ◽  
M Dziubinski ◽  
D Conen ◽  
J.S Healey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
The United States ◽  
Funding Source ◽  
Ecg Monitoring ◽  
P Waves ◽  
Diagnostic Reliability ◽  
Monitoring Period ◽  
Ambulatory Ecg ◽  
Ambulatory Ecg Monitoring ◽  
Long Term Follow Up

Abstract Background Premature atrial complexes (PACs) predict incident atrial fibrillation (AF) in long-term follow-up studies. It is unclear whether frequent PACs on ambulatory ECG recordings indicate a higher likelihood of concurrent, undiagnosed AF. Furthermore, the reproducibility of a 24 h PAC count is unclear. Objectives To determine if frequent PACs on 24 h ambulatory ECG monitoring predicts concurrent AF during subsequent, prolonged ECG monitoring and to assess the diagnostic reliability of PAC counts on a 24 hour ECG recording. Methods AF was defined as ≥30 seconds of irregular rhythm without P waves, which was detected by a proprietary algorithm and manually verified. The proportion of AF occurrence during the remainder of the monitoring period was calculated for pre-specified levels of PACs during the first 24 h, and a function describing the association was fitted. The diagnostic reproducibility of a 24 h PAC count was assessed by calculating the likelihood of a PAC count ≥1000/day during the entire monitoring duration for prespecified PAC count levels during the first 24h. Results The study population comprised 20,973 patients (41% men, mean age 69.5 years) who had recorded an ambulatory ECG with a monitoring duration of 4–30 days in the United States during the year 2017 (median monitoring duration 16 days). AF was detected in 2,029 (9.7%) of patients and the median time to first occurrence of AF was 5 days. PAC frequency during the first 24 h was associated with AF during the monitoring period beyond the first 24 h, increasing steadily from 4.2% among those with 0–5 PACs, to a plateau around 17% among those with 250–1000 PACs per day and above. (Fig. 1A). The reproducibility of low PAC counts was good. Only 5.5% of patients with 0–5 PACs during the first 24 h of monitoring (31.8% of the population), had ≥1000 PACs on an alternate monitoring day. In contrast, among subjects with 100 PACs the probability of a day with ≥1000 PACs was close to 50% (Fig. 1B). Conclusion In patients undergoing ambulatory ECG monitoring, frequent PACs during the first 24 h indicate a higher likelihood of AF occurrence during subsequent days of monitoring. Less than 5 PACs during the first 24 h indicate a low probability of AF or frequent PACs on a subsequent day of ECG monitoring. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Swedish Heart and Lung Foundation; The Swedish Heart and Lung Association

Abstract 4307: New Insights into Surgical Atrial Fibrillation Ablation Therapy: Initial Experience with a Novel Permanently Implantable Heart Rhythm Monitor Device

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Thorsten Hanke ◽  
Antje Karlub ◽  
Efstratios Charitos ◽  
Axel Hagemann ◽  
Bernhard Graf ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rhythm ◽  
Holter Monitoring ◽  
Ecg Monitoring ◽  
Time Intervals ◽  
Ablation Therapy ◽  
Implantable Monitor ◽  
Monitor Device ◽  
Rhythm Monitoring ◽  
Af Recurrence

Introduction: Surgical atrial fibrillation (AF) therapy is gaining widespread acceptance among cardiothoracic surgeons. However, assessment of therapy success is until now solely based on short time -“snapshot”-rhythm surveillance often at irregular time intervals. In order to evaluate the ablation’s success we intraindividually compared two different types of follow-up strategies: conventional 24h-Holter monitoring and direct long time rhythm surveillance achieved by a new implantable monitor device (IRMD). Methods: 20 cardiac surgical patients (male 16, mean age 69±9y) with a mean AF of 30±48m (paroxysmal n=7, persistent n=9, long standing persistent n=4) were treated intraoperatively with epicardial high intensity focus ultrasound (HIFU) ablation (+CABG n=10, +AVR n=5, +AVR/CABG n=2, +valve preserving ascending aorta replacement n=2, +endoaneurymoraphy n=1, lone atrial fibrillation n=1). Postoperative heart rhythm monitoring was accomplished in all patients with a 24h-Holter-monitor at prescheduled time intervals and additionally with a new implantable monitor device (Reveal XT, Medtronic®, MN, USA). A more than 0.5% of “time in AF” as reported by the IRMD was considered as recurrence of AF. Telemetry of the IRMD was performed simultaneously after completion of 24h-Holter monitoring. Results: During a mean FU of 8.7±1.4m a total of 29 24 h-Holter-monitors were obtained. Sinus rhythm was documented in 21, the IMRD however revealed AF recurrence in 11 of these cases. Thus, conventional 24 h ECG monitoring failed to identify AF recurrence in 59% of cases (p<0.027). Success rate after surgical ablation therapy (defined as freedom from AF recurrence of more than 0.5% of observational period) was 72% with 24h Holter monitoring, but only 35% using continuous ECG monitoring with IRMD. Conclusion: In order to evaluate better “real life” outcomes after atrial fibrillation ablation therapy, long term continuous heart rhythm surveillance instead of -“snapshot” - heart rhythm monitoring is mandatory. This is particularly important for the decision to alter medical therapies, e.g. oral anticoagulation or antiarrhythmic treatment.

scholarly journals Atrial fibrillation detection using single lead portable electrocardiographic monitoring: a systematic review and meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e024178 ◽  
Author(s):  
Satish Ramkumar ◽  
Nitesh Nerlekar ◽  
Daniel D’Souza ◽  
Derek J Pol ◽  
Jonathan M Kalman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Detection Rate ◽  
Heart Rhythm ◽  
Holter Monitoring ◽  
Significant Heterogeneity ◽  
Ecg Monitoring ◽  
Quality Of Reporting ◽  
Electrocardiographic Monitoring ◽  
Monitoring Time ◽  
Meta Regression

ObjectivesRecent technology advances have allowed for heart rhythm monitoring using single-lead ECG monitoring devices, which can be used for early diagnosis of atrial fibrillation (AF). We sought to investigate the AF detection rate using portable ECG devices compared with Holter monitoring.Setting, participants and outcome measuresWe searched the Medline, Embase and Scopus databases (conducted on 8 May 2017) using search terms related to AF screening and included studies with adults aged >18 years using portable ECG devices or Holter monitoring for AF detection. We excluded studies using implantable loop recorders and pacemakers. Using a random-effects model we calculated the overall AF detection rate. Meta-regression analysis was performed to explore potential sources for heterogeneity. Quality of reporting was assessed using the tool developed by Downs and Black.ResultsPortable ECG monitoring was used in 18 studies (n=117 436) and Holter monitoring was used in 36 studies (n=8498). The AF detection rate using portable ECG monitoring was 1.7% (95% CI 1.4 to 2.1), with significant heterogeneity between studies (p<0.001). There was a moderate linear relationship between total monitoring time and AF detection rate (r=0.65, p=0.003), and meta-regression identified total monitoring time (p=0.005) and body mass index (p=0.01) as potential contributors to heterogeneity. The detection rate (4.8%, 95% CI 3.6% to 6.0%) in eight studies (n=10 199), which performed multiple ECG recordings was comparable to that with 24 hours Holter (4.6%, 95% CI 3.5% to 5.7%). Intermittent recordings for 19 min total produced similar AF detection to 24 hours Holter monitoring.ConclusionPortable ECG devices may offer an efficient screening option for AF compared with 24 hours Holter monitoring.PROSPERO registration numberCRD42017061021.

scholarly journals Nurse Led Smartphone Electrographic Monitoring for Atrial Fibrillation after Ischemic Stroke: SPOT-AF

2020 ◽  
Vol 22 (3) ◽  
pp. 387-395 ◽  
Author(s):  
Bernard Yan ◽  
Hans Tu ◽  
Christina Lam ◽  
Corey Swift ◽  
Ma Sze Ho ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulant ◽  
Primary Outcome ◽  
Holter Monitoring ◽  
Secondary Outcome ◽  
Ecg Monitoring ◽  
History Of ◽  
Ischemic Attack ◽  
Electrocardiogram Ecg ◽  
Holter Recordings

Background and Purpose Paroxysmal atrial fibrillation (PAF) underlying acute stroke frequently evades detection by standard practice, considered to be a combination of routine electrocardiogram (ECG) monitoring, and 24-hour Holter recordings. We hypothesized that nurse-led in-hospital intermittent monitoring approach would increase PAF detection rate.Methods We recruited patients hospitalised for stroke/transient ischemic attack, without history of atrial fibrillation (AF), in a prospective multi-centre observational study. Patients were monitored using a smartphone-enabled handheld ECG (iECG) during routine nursing observations, and underwent 24-hour Holter monitoring according to local practice. The primary outcome was comparison of AF detection by nurse-led iECG versus Holter monitoring in patients who received both tests: secondary outcome was oral anticoagulant commencement at 3-month following PAF detection.Results One thousand and seventy-nine patients underwent iECG monitoring: 294 had iECG and Holter monitoring. AF was detected in 25/294 (8.5%) by iECG, and 8/294 (2.8%) by 24-hour Holter recordings (P<0.001). Median duration from stroke onset to AF detection for iECG was 3 days (interquartile range [IQR], 2 to 6) compared with 7 days (IQR, 6 to 10) for Holter recordings (P=0.02). Of 25 patients with AF detected by iECG, 11 were commenced on oral anticoagulant, compared to 5/8 for Holter. AF was detected in 8.8% (69/785 patients) who underwent iECG recordings only (P=0.8 vs. those who had both iECG and 24-hour Holter).Conclusions Nurse-led in-hospital iECG surveillance after stroke is feasible and effective and detects more PAF earlier and more frequently than routine 24-hour Holter recordings. Screening with iECG could be incorporated into routine post-stroke nursing observations to increase diagnosis of PAF, and facilitate institution of guideline-recommended anticoagulation.

scholarly journals Diagnostic utility of long-term remote ECG monitoring in compare with 24 hour Holter monitoring in patients with atrial fibrillation after catheter radiofrequency ablation in the early postoperative period

2018 ◽  
Vol 90 (12) ◽  
pp. 12-16
Author(s):  
G V Ryabykina ◽  
Z O Shokhzodaeva ◽  
O V Sapelnikov ◽  
M I Makeev ◽  
E Sh Kozhemyakina ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Remote Monitoring ◽  
Pulmonary Veins ◽  
Holter Monitoring ◽  
Early Postoperative Period ◽  
Diagnostic Utility ◽  
Ecg Monitoring ◽  
Af Recurrence

Aim. To evaluate the diagnostic utility of long-term remote monitoring of ECG compared with 24 hour Holter monitoring for the detection of cardiac arrhythmias and conduction disturbance in patients with atrial fibrillation (AF) after catheter radiofrequency ablation (RFA; isolation) of the pulmonary veins. Materials and methods. The study included 62 patients aged 58.5±11.1 years, with paroxysmal or persistent AF, after catheter RFA (pulmonary veins isolation). Patients underwent long-term remote ECG monitoring, 24 hour Holter monitoring and transthoracic echocardiogram. Results and discussion. After 24 hour Holter monitoring of 62 patients with AF after RFA in 21 of them (33.9%) was detected early recurrence of AF. Remote ECG monitoring of 18 patients, detected AF in 7 patients (39%), 2 of them were asymptomatic AF recurrence. 24 hour Holter monitoring of the same 18 patients AF recurrence was not detected at all (0%). Conclusion. Both of devices, long-term remote monitoring of ECG and 24 hour Holter monitoring detected 45.2% of recurrence of AF. Over the wearing of both devises 24 hour Holter and long-term remote monitor the last detected more events among 18 patients (33% vs 0%). Two evens of AF recurrence were asymptomatic.

Abstract TP231: Echocardiographically Identified Left Atrial Enlargement is Associated With Non-valvular Paroxysmal Atrial Fibrillation (PAF) and is a Surrogate for PAF Associated Risk for Embolic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Adeniyi O Molajo
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Stroke Risk ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Ecg Monitoring ◽  
Ambulatory Ecg ◽  
Ambulatory Ecg Monitoring

Introduction: Paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation are risk factors for systemic embolism including stroke. Both are indication for anticoagulation. Many patients with stroke in sinus rhythm are shown on ambulatory ECG monitoring to have PAF. PAF is difficult to diagnose on ambulatory ECG monitoring. A persistent marker for PAF will be useful to identify need for anticoagulant to reduce stroke risk due to PAF. Echocardiographic variable with a high predictive value for PAF is desirable. Objective: The purpose of the study was to investigate the relationship between left atrial (LA) size and proneness to paroxysmal atrial fibrillation and assess its reliability as a surrogate for diagnosing non valvular PAF. Method: Echo Database for patients with measured LA volume index, in sinus rhythm without history of intervention for atrial fibrillation, pharmacological therapy, and cardioversion or ablation therapy over a seven year period was reviewed. Patients with enlarged LA Volume index (>28ml/M 2 ) were selected. Seven Day ambulatory ECG monitoring was performed in these patients, ResultEchocardiogram data of 245 patients were available for analysis. 41 had greater than mild mitral valve regurgitation and were excluded from further analysis. Age range was 37-93. 99 were male. 211 patients had LA volume index data available. In 8 patients in sinus rhythm on ambulatory ECG, LA volume index was mildly increased (28-34 ml/M 2) In 16 patients with PAF on ambulatory ECG, LA volume index was mildly increased (28-34 ml/M 2 ) In 100 patients with PAF on ambulatory ECG, LA volume index was moderately increased (35-40 ml/M 2 ) In 88 patients with PAF on ambulatory ECG, LA volume index was severely increased (>40 ml/M 2 ) Conclusion: In patients with moderately and severely enlarged LA volume index, there was a high prevalence of paroxysmal atrial fibrillation on ambulatory ECG monitoring. Left Atrial volume index could serve as an echocardiographic surrogate for PAF and identify indication for anticoagulation to reduce stroke risk. It Is More Easily Identifiable Surrogate For PAF Than Ambulatory ECG Monitoring In Stroke Risk Assessment.

scholarly journals Smartphone ECG Monitoring System Helps Lower Emergency Room and Clinic Visits in Post–Atrial Fibrillation Ablation Patients

2020 ◽  
Vol 14 ◽  
pp. 117954682090150 ◽  
Author(s):  
Mossab Aljuaid ◽  
Qussay Marashly ◽  
Jad AlDanaf ◽  
Ibrahim Tawhari ◽  
Michel Barakat ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Room ◽  
Continuous Monitoring ◽  
Holter Monitoring ◽  
P Value ◽  
Ecg Monitoring ◽  
Event Monitoring ◽  
Routine Monitoring ◽  
Monitoring Group

Aim: To evaluate the effectiveness of using a smartphone-based electrocardiography (ECG) monitoring device (ECG Check) on the frequency of clinic or emergency room visits in patients who underwent ablation of atrial fibrillation (AF). Methods: Two groups of patients were identified and compared: The conventional monitoring group (CM group) included patients who were prescribed conventional event monitoring or Holter monitoring systems. The ECG Check group (EC group) included patients who were prescribed the ECG Check device for continuous monitoring in addition to conventional event monitoring. The primary outcome was the number of patient visits to clinic or emergency room. The feasibility, accuracy, and detection rate of mobile ECG Check were also evaluated. Results: Ninety patients were studied (mean age: 66.2 ± 11 years, 64 males, mean CHA2DS2-VASc score: 2.6 ± 2). In the EC group, forty-five patients sent an average of 52.8 ± 6 ECG records for either routine monitoring or symptoms of potential AF during the follow-up period. The rhythm strips identified sinus rhythm (84.7%), sinus tachycardia (8.4%), AF (4.2%), and atrial flutter (0.9%). Forty-two EC transmissions (1.8%) were uninterpretable. Six patients (13%) in the EC group were seen in the clinic or emergency room over a 100-day study period versus 16 (33%) in the standard care arm ( P value < 0.001). Conclusions: Use of smartphone-based ECG monitoring led to a significant reduction in AF-related visits to clinic or emergency department in the postablation period.

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