Diagnostic Utility of a Novel Leadless Arrhythmia Monitoring Device

Although extending the duration of ambulatory electrocardiographic monitoring beyond 24 to 48 hours can improve the detection of arrhythmias, lead-based (Holter) monitors might be limited by patient compliance and other factors. We, therefore, evaluated compliance, analyzable signal time, interval to arrhythmia detection, and diagnostic yield of the Zio Patch, a novel leadless, electrocardiographic monitoring device in 26,751 consecutive patients. The mean wear time was 7.6 ± 3.6 days, and the median analyzable time was 99% of the total wear time. Among the patients with detected arrhythmias (60.3% of all patients), 29.9% had their first arrhythmia and 51.1% had their first symptom-triggered arrhythmia occur after the initial 48-hour period. Compared with the first 48 hours of monitoring, the overall diagnostic yield was greater when data from the entire Zio Patch wear duration were included for any arrhythmia (62.2% vs 43.9%, p <0.0001) and for any symptomatic arrhythmia (9.7% vs 4.4%, p <0.0001). For paroxysmal atrial fibrillation (AF), the mean interval to the first detection of AF was inversely proportional to the total AF burden, with an increasing proportion occurring after 48 hours (11.2%, 10.5%, 20.8%, and 38.0% for an AF burden of 51% to 75%, 26% to 50%, 1% to 25%, and <1%, respectively). In conclusion, extended monitoring with the Zio Patch for ≤14 days is feasible, with high patient compliance, a high analyzable signal time, and an incremental diagnostic yield beyond 48 hours for all arrhythmia types. These findings could have significant implications for device selection, monitoring duration, and care pathways for arrhythmia evaluation and AF surveillance. Although extending the duration of ambulatory electrocardiographic monitoring beyond 24 to 48 hours can improve the detection of arrhythmias, lead-based (Holter) monitors might be limited by patient compliance and other factors. We, therefore, evaluated compliance, analyzable signal time, interval to arrhythmia detection, and diagnostic yield of the Zio Patch, a novel leadless, electrocardiographic monitoring device in 26,751 consecutive patients. The mean wear time was 7.6 ± 3.6 days, and the median analyzable time was 99% of the total wear time. Among the patients with detected arrhythmias (60.3% of all patients), 29.9% had their first arrhythmia and 51.1% had their first symptom-triggered arrhythmia occur after the initial 48-hour period. Compared with the first 48 hours of monitoring, the overall diagnostic yield was greater when data from the entire Zio Patch wear duration were included for any arrhythmia (62.2% vs 43.9%, p <0.0001) and for any symptomatic arrhythmia (9.7% vs 4.4%, p <0.0001). For paroxysmal atrial fibrillation (AF), the mean interval to the first detection of AF was inversely proportional to the total AF burden, with an increasing proportion occurring after 48 hours (11.2%, 10.5%, 20.8%, and 38.0% for an AF burden of 51% to 75%, 26% to 50%, 1% to 25%, and <1%, respectively). In conclusion, extended monitoring with the Zio Patch for ≤14 days is feasible, with high patient compliance, a high analyzable signal time, and an incremental diagnostic yield beyond 48 hours for all arrhythmia types. These findings could have significant implications for device selection, monitoring duration, and care pathways for arrhythmia evaluation and AF surveillance. Ambulatory electrocardiography is a widely used diagnostic tool to detect arrhythmias for a variety of symptoms and conditions.1Crawford M.H. Bernstein S.J. Deedwania P.C. DiMarco J.P. Ferrick K.J. Garson Jr., A. Green L.A. Greene H.L. Silka M.J. Stone P.H. Tracy C.M. Gibbons R.J. Alpert J.S. Eagle K.A. Gardner T.J. Gregoratos G. Russell R.O. Ryan T.H. Smith Jr., S.C. ACC/AHA guidelines for ambulatory electrocardiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography). Developed in collaboration with the North American Society for Pacing and Electrophysiology.J Am Coll Cardiol. 1999; 34: 912-948Abstract Full Text Full Text PDF PubMed Scopus (220) Google Scholar, 2Zimetbaum The of ambulatory arrhythmia monitoring in 1999; PubMed Scopus Google Scholar, A. Ambulatory arrhythmia the PubMed Scopus Google of and ambulatory electrocardiographic monitors have to 48 monitoring (Holter) monitoring A. Ambulatory arrhythmia the PubMed Scopus Google Scholar, J.S. Ambulatory electrocardiographic on atrial Am Coll Cardiol. Full Text Full Text PDF PubMed Scopus Google monitoring the to 48-hour duration might improve the diagnostic yield of have limited by patient compliance, the analyzable wear time, and A. Ambulatory arrhythmia the PubMed Scopus Google Scholar, J.S. Ambulatory electrocardiographic on atrial Am Coll Cardiol. Full Text Full Text PDF PubMed Scopus Google Scholar, A. to for atrial fibrillation PubMed Scopus Google Scholar, of monitors in patients with Full Text Full Text PDF PubMed Scopus Google Scholar, A. yield and 48-hour monitoring in patients with a PubMed Google Scholar, and of in the of and Cardiol. Full Text Full Text PDF PubMed Scopus Google Scholar, of monitors for arrhythmia Cardiol. 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Among patients with arrhythmias, of had arrhythmias in the first days of monitoring the of monitoring, of all patients with arrhythmias the of monitoring were Among the patients with symptomatic arrhythmias, of patients with arrhythmias the of were detected by the with in the first days patients might monitoring after the first symptomatic evaluated the of patients the for In days of monitoring were to of all patients with yield of arrhythmia detection time. 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A. after atrial fibrillation to with a novel PubMed Scopus Google Scholar, evaluation of monitoring for the detection of atrial fibrillation from patients and implications for monitoring after PubMed Scopus Google data have ≤14 days of monitoring can improve AF detection in paroxysmal when the AF burden was monitoring be a of an is with the Zio Patch, is had of patients a Zio Patch for might the of all patients for monitoring, of arrhythmia could have the device arrhythmia of duration were included in and is the of of detected with extended monitoring, might be the findings for symptom-triggered arrhythmias of duration were significant and with the overall have Zio and for A. of a monitoring device in the of atrial a PubMed Scopus Google in signal and detection could have to in the of arrhythmia detection and the Zio Patch and other monitoring the be to be is the and of and a significant in the The have of to Ambulatory electrocardiography is a widely used diagnostic tool to detect arrhythmias for a variety of symptoms and conditions.1Crawford M.H. Bernstein S.J. Deedwania P.C. DiMarco J.P. Ferrick K.J. Garson Jr., A. Green L.A. Greene H.L. Silka M.J. Stone P.H. Tracy C.M. Gibbons R.J. Alpert J.S. Eagle K.A. Gardner T.J. Gregoratos G. Russell R.O. Ryan T.H. Smith Jr., S.C. ACC/AHA guidelines for ambulatory electrocardiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography). Developed in collaboration with the North American Society for Pacing and Electrophysiology.J Am Coll Cardiol. 1999; 34: 912-948Abstract Full Text Full Text PDF PubMed Scopus (220) Google Scholar, 2Zimetbaum The of ambulatory arrhythmia monitoring in 1999; PubMed Scopus Google Scholar, A. Ambulatory arrhythmia the PubMed Scopus Google of and ambulatory electrocardiographic monitors have to 48 monitoring (Holter) monitoring A. Ambulatory arrhythmia the PubMed Scopus Google Scholar, J.S. Ambulatory electrocardiographic on atrial Am Coll Cardiol. Full Text Full Text PDF PubMed Scopus Google monitoring the to 48-hour duration might improve the diagnostic yield of have limited by patient compliance, the analyzable wear time, and A. Ambulatory arrhythmia the PubMed Scopus Google Scholar, J.S. Ambulatory electrocardiographic on atrial Am Coll Cardiol. Full Text Full Text PDF PubMed Scopus Google Scholar, A. to for atrial fibrillation PubMed Scopus Google Scholar, of monitors in patients with Full Text Full Text PDF PubMed Scopus Google Scholar, A. yield and 48-hour monitoring in patients with a PubMed Google Scholar, and of in the of and Cardiol. Full Text Full Text PDF PubMed Scopus Google Scholar, of monitors for arrhythmia Cardiol. 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Among patients with arrhythmias, of had arrhythmias in the first days of monitoring the of monitoring, of all patients with arrhythmias the of monitoring were Among the patients with symptomatic arrhythmias, of patients with arrhythmias the of were detected by the with in the first days patients might monitoring after the first symptomatic evaluated the of patients the for In days of monitoring were to of all patients with the of 26,751 patients with ambulatory monitoring for high patient compliance a high analyzable time, and a of arrhythmias beyond the first 48 hours of These findings were all arrhythmia and the of symptom-triggered These findings extended monitoring with the Zio Patch is and arrhythmias could be with 48-hour high wear time and analyzable time of the Zio Patch might have from the of monitoring with the of the with and a have compliance with lead-based extended monitoring and of the high of of and to the A. to for atrial fibrillation PubMed Scopus Google Scholar, Russell for ambulatory Full Text Full Text PDF PubMed Scopus Google Scholar, J.S. The of a PubMed Scopus Google Scholar, A. G. and atrial fibrillation in patients PubMed Scopus Google monitors with to can the and be with In the the device for days, the device for the duration The for were a in the from days of monitoring to days the and in The mean wear time from to days the period. The Zio of and could have to the patient compliance and signal all arrhythmia the diagnostic yield with monitoring beyond 48 Among patients with paroxysmal the time to the detection of the first AF the total AF burden findings with from a of patients with AF Zio and A. of a monitoring device in the of atrial a PubMed Scopus Google with monitoring, AF were in of after Zio Patch patients had a in of by the Zio findings could have significant implications for and have monitoring with the diagnostic yield for AF after of A. 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