Key result
Wearable ECG monitoring detects clinically significant AF in ~15% of patients with short AHREs.
Why the study?
Brief atrial high-rate episodes (<30 s) detected during standard 24-hour Holter monitoring have uncertain prognostic value, and the diagnostic value of prolonged wearable ECG monitoring for detecting clinically significant AF in these patients needed assessment.
Does long-term wearable ECG monitoring improve the detection of clinically significant atrial fibrillation in patients with short atrial high-rate episodes (<30 s) identified on 24-hour Holter monitoring?
Observational (n=157)
Does long-term wearable ECG monitoring improve the detection of clinically significant atrial fibrillation in patients with short atrial high-rate episodes (<30 s) identified on 24-hour Holter monitoring?
Long-term wearable ECG monitoring detected clinically significant atrial fibrillation (≥30 s) in 15.4% of patients who only had brief (<30 s) atrial high-rate episodes on prior 24-hour Holter monitoring, particularly among those with higher baseline arrhythmic burden.
Should not yet change practice for brief AHREs; leaves open diagnostic yield of extended monitoring in larger prospective cohorts.
Background Atrial high-rate episodes (AHREs) represent a subclinical phenotype of atrial tachyarrhythmias and may precede atrial fibrillation (AF). Brief episodes (<30 s) detected during standard 24-hour Holter monitoring have uncertain prognostic value and may remain underestimated. Prolonged wearable ECG monitoring may improve detection of clinically significant AF and enhance risk stratification. Aim To assess the diagnostic value of long-term wearable ECG monitoring for detecting clinically significant AF in patients with AHRE identified during 24-hour Holter ECG prescreening. Materials and Methods The study was conducted in two stages. Stage I included 157 patients with AHREs (<30 s) detected on 24-hour Holter ECG monitoring. The mean number of paroxysms was 3.37 ± 6.03 per day, the total duration of atrial arrhythmia was 39.6 ± 92.8 seconds per day, and the mean AF burden was 0.22 ± 2.06%. Stage II involved long-term wearable ECG monitoring in 13 selected patients. The mean age was 57.7 ± 9.8 years; 7 (53.8%) were men. Obesity (BMI ≥30) was present in 5 (38.5%) patients, arterial hypertension in 10 (76.9%), chronic heart failure in 4 (30.8%), and ischemic heart disease in 3 (23.1%). The mean CHA2DS2-VA score was 1.77 ± 1.09, and the mean AFEQT score was 76.1 ± 9.8. The device performed photoplethysmographic rhythm monitoring at rest and triggered alerts in case of suspected arrhythmia, prompting a short single-lead ECG recording (Lead I). The protocol included four scheduled ECG recordings daily, with additional patient- or device-initiated recordings. All ECGs were physician-verified for AF. Results Monitoring lasted 12.9 ± 2.6 days with 93.8 ± 5.1% valid recording time. A total of 1200 short (30-second) ECG recordings were obtained (92.3 ± 55.5 per patient), generating 124 arrhythmia alerts (9.5 ± 5.3 per patient). An average of 10.3 ± 12.7 ECGs per patient were performed at night. Subjective symptoms were reported by 9 (69.2%) patients, whereas asymptomatic episodes were documented in 6 (46.2%). AF of any duration was newly detected in 3 of 13 patients (23.1%). Clinically significant AF (≥30 s) was identified in 2 patients (15.4%), despite prior negative 24-hour Holter monitoring. Baseline Holter-derived atrial arrhythmic burden was higher in patients with subsequent AF detection compared with those without AF (median 140 [136–142.5] vs. 8 [5–27] seconds per day). Conclusions In patients with AHRE (<30 s), long-term wearable ECG monitoring identified clinically significant AF (≥30 s) in 15.4% of cases and AF of any duration in 23.1%. Higher baseline Holter-derived arrhythmic burden was associated with subsequent AF detection. These findings suggest that short AHREs may represent an early stage of AF and warrant prolonged monitoring for timely diagnosis and improved risk stratification.Two-week summary of wearable ECG monitoring.
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Danilevich et al. (2026) conducted an observational in Atrial high-rate episodes (AHREs) (n=157). Long-term wearable ECG monitoring was evaluated on Detection of clinically significant atrial fibrillation (≥30 s). Long-term wearable ECG monitoring identified clinically significant atrial fibrillation (≥30 s) in 15.4% and AF of any duration in 23.1% of patients with short AHREs (<30 s).
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