Key result
A smartphone-based one-lead ECG monitor differentiated supraventricular tachycardia from inappropriate sinus tachycardia with 89% sensitivity and 91% specificity compared to an invasive electrophysiology study.
Why the study?
SVT is difficult to document due to its intermittent nature, and no data existed on whether smartphone-based one-lead ECG monitors could differentiate inappropriate sinus tachycardia from regular SVT.
Does a smartphone-based one-lead ECG accurately differentiate supraventricular tachycardia from inappropriate sinus tachycardia in patients with known SVT?
Observational (n=75)
Blinded evaluators
No
Does a smartphone-based one-lead ECG accurately differentiate supraventricular tachycardia from inappropriate sinus tachycardia in patients with known SVT?
A smartphone-based one-lead ECG can reliably differentiate SVT from inappropriate sinus tachycardia with approximately 90% accuracy, which may help avoid unnecessary invasive EP studies.
May support non-invasive SVT-IST differentiation; leaves open prospective validation before clinical adoption.
INTRODUCTION: Supraventricular tachycardias (SVT) are often difficult to document due to their intermittent, short-lasting nature. Smartphone-based one-lead ECG monitors (sECG) were initially developed for the diagnosis of atrial fibrillation. No data have been published regarding their potential role in differentiating inappropiate sinus tachycardia (IST) from regular SVT. If cardiologists could distinguish IST from SVT in sECG, economic health care burden might be significantly reduced. METHODS: We prospectively recruited 75 consecutive patients with known SVT undergoing an EP study. In all patients, four ECG were recorded: a sECG during SVT and during sinus tachycardia and respective 12-lead ECG. Two experienced electrophysiologists were blinded to the diagnoses and separately evaluated all ECG. The electrophysiologists' blinded interpretation of sECG recordings showed a sensitivity of 89% and a specificity of 91% for the detection of SVT (interobserver agreement κ = 0.76). In high-quality sECG recordings (68%), sensitivity rose to 95% with a specificity of 92% (interobserver agreement of κ = 0.91). Specificity increased to 96% when both electrophysiologists agreed on the diagnosis. Respective 12-lead ECG had a sensitivity of 100% and specificity of 98% for the detection of SVT. CONCLUSION: A smartphone-based one-lead ECG monitor allows for differentiation of SVT from IST in about 90% of cases. These results should encourage cardiologists to integrate wearables into clinical practice, possibly reducing time to definitive diagnosis of an arrhythmia and unnecessary EP procedures. A smartphone-based one lead ECG device (panel A) can be used reliably to differentiate supraventricular tachycardia (panel B) from inappropriate sinus tachycardia when compared to a simultaneously conducted gold-standard electrophysiology study (panels C, D).
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Wegner et al. (2021) conducted an observational in Supraventricular tachycardia (n=75). Smartphone-based one-lead ECG monitor (AliveCor Kardia) vs. 12-lead ECG and invasive EP study was evaluated on Sensitivity for the detection of supraventricular tachycardia vs inappropriate sinus tachycardia (Sensitivity 89%, Specificity 91%). A smartphone-based one-lead ECG monitor differentiated supraventricular tachycardia from inappropriate sinus tachycardia with 89% sensitivity and 91% specificity compared to an invasive electrophysiology study.
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