HRS Study: Online, Full Disclosure ECG Monitoring Outperforms Offline Holter and Patches
HRS Study: Online, Full Disclosure ECG Monitoring Outperforms Offline Holter and Patches
Though the precise cause of ischemic stroke cannot be determined in 20 to 40% of cases (cryptogenic stroke), paroxysmal atrial fibrillation (PAF) is often a major contributing factor. A wide variety of methods are used to detect PAF with monitoring durations that typically range from 1-30 days. If left untreated, PAF can lead to heart-related complications, including blood clots, stroke, and heart failure.
Given the often asymptomatic and paroxysmal nature of atrial fibrillation, it’s become evident that relying on symptoms and/or intermittent monitoring alone will frequently underestimate the presence and extent of the arrhythmia. For example, a study comparing atrial fibrillation monitoring strategies after cryptogenic stroke found that:
- The duration of monitoring needed to detect AF was inversely proportional to AF burden.
- According to its investigators, “long periods of monitoring may be necessary to detect infrequent but clinically important paroxysms of AF.”
The long-term monitoring method in this oft-cited study was insertable cardiac monitors (ICMs), which are invasive and costly. The authors also noted that the question remains whether currently available forms of external monitoring can substitute for the long-term continuous monitoring afforded by an ICM.
A new study presented at the 2018 Heart Rhythm Society Annual Scientific Sessions indicates that one external monitoring method, the PocketECG mobile arrhythmia monitoring solution, could be a viable alternative. Its results showed that continuous monitoring with the PocketECG provided significantly higher diagnostic yield (DY) than two frequently used fixed duration offline methods – 24- and 48-hour Holter monitors and multi-day patches.
Extending Monitoring Duration Increases Diagnostic Yield
This groundbreaking research analyzed 16,595 cardiac telemetry reports based on the PocketECG online monitoring system, which transmits full disclosure ECG signals for up to 30 days. Its continuous and fully labeled recordings, which lasted between 1 and 30 days (mean duration: 18.1 ± 9.9 days), were used to determine the monitoring duration required to detect the first AF episode for various AF burdens (AFBs). The study then evaluated the impact of monitoring duration on diagnostic yield (DY) in patients with PAF (for AFB ≤ 1% and AFB ≤ 10%) and analyzed the difference in DY between the online method and simulated offline methods (24- and 48-hour Holter and 11- and 18-day patches).
Study Results
| Pocket ECG Comparison with different Methods and Durations | AF Burden | DY Results |
|---|---|---|
| First 24h of Holter monitoring | ≤ 1% | PocketECG 6x DY |
| First 24h of Holter monitoring | ≤ 10% | PocketECG 4x higher DY |
| First 48h of Holter monitoring | ≤ 1% | PocketECG 3.5x higher DY |
| First 48h of Holter monitoring | ≤ 10% | PocketECG 2.5x higher DY |
| First 11 days with offline patch | ≤ 1% | PocketECG 36% higher DY |
| First 11 days with offline patch | ≤ 10% | PocketECG 25% higher DY |
| First 18 days with offline patch | ≤ 1% | PocketECG 14% higher DY |
| First 18 days with offline patch | ≤ 10% | PocketECG 10% higher DY |
You can access study results here.
Continuous Online Monitoring Also Lets Physicians Control Duration Time
The fixed duration of any offline method can lengthen the time to diagnosis, since monitoring will continue for a set time even if an arrhythmia occurs soon after it starts. Conversely, PocketECG online monitoring provides clinicians ongoing access to diagnostic findings, which enables them to end a study once an arrhythmia is detected or extend it when further monitoring is required.