Key result
Event-triggered ECG detects similar arrhythmia rates vs continuous Holter but shows lower AF screening sensitivity.
Why the study?
Prolonged ECG monitoring is standard for AF screening, but equivalence of 7-day event triggered ECG versus 7-day continuous Holter ECG recording was uncertain.
Does 7-day event triggered ECG recording provide equivalent atrial fibrillation screening compared to 7-day continuous Holter ECG recording in patients with known or suspected paroxysmal atrial fibrillation?
Observational (n=100)
Does 7-day event triggered ECG recording provide equivalent atrial fibrillation screening compared to 7-day continuous Holter ECG recording in patients with known or suspected paroxysmal atrial fibrillation?
Absolute Event Rate: 37% vs 42%
p-value: p=0.56
7-day event-triggered ECG has lower sensitivity than continuous Holter for atrial fibrillation screening, primarily due to shorter effective monitoring duration, though it requires less analysis time.
Event-triggered ECG warrants caution for AF screening due to lower sensitivity; leaves open optimal monitoring strategies in observational data.
OBJECTIVE: Prolonged ECG monitoring is standard for atrial fibrillation (AF) screening. This study investigated whether 7-day event triggered (tECG) ECG recording is equivalent to 7-day continuous Holter (cECG) ECG recording for AF screening. DESIGN: Both a cECG (Lifecard CF) and a tECG (R.Test Evolution 3) were simultaneously worn for 7 days by patients with known or suspected paroxysmal AF. RESULTS: In 100 corresponding recordings, median effective duration of monitoring was 165 h (range 10-170 h) for cECG and 137 h (0-169 h) for tECG (p<0.001). Median number and total duration of arrhythmias (AF, atrial flutter or atrial tachycardia) of ≥30 s duration recorded by cECG were 10 (1-428) and 1030 min (≤1-10,020), respectively. An arrhythmia was recorded in 42 cECGs (42%) versus 37 tECGs (37%, p=0.56). Triggered ECG failed to record an arrhythmia in cECG positive cases because of interrupted monitoring in four cases and because of recording failure in one case. Sensitivity, specificity, and positive and negative predictive values of tECG therefore were 88%, 100%, 100%, and 92%, respectively. Quantitative cECG analysis required a median of 20 min (3-205 min) and qualitative tECG analysis 4 min (1-20 min; p<0.001). Skin irritation was a frequent side effect (42%) resulting in premature removal of devices in 16% of patients. CONCLUSION: Sensitivity of tECG for AF screening as compared to cECG is lower, mainly because of shorter effective monitoring duration. Qualitative tECG analysis is less time consuming than quantitative cECG analysis. Skin irritation is a frequent side effect and reason for premature device removal.
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Roten et al. (2012) conducted an observational in Known or suspected paroxysmal atrial fibrillation (n=100). 7-day event triggered ECG recording (tECG) vs. 7-day continuous Holter ECG recording (cECG) was evaluated on Detection of an arrhythmia (atrial fibrillation, atrial flutter, or atrial tachycardia) of ≥30 s duration (p=0.56). A 7-day event-triggered ECG detected arrhythmias in 37% of patients compared to 42% with a 7-day continuous Holter ECG (p=0.56), demonstrating lower sensitivity for atrial fibrillation screening.
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