Comparison of a smartphone-based ECG recording system with a standard cardiac event monitor in the investigation of palpitations in children

Macinnes, Mairi; Martin, Nicholas; Fulton, Helen; McLeod, Karen

doi:10.1136/archdischild-2018-314901

Cited by 30 publications

(15 citation statements)

References 13 publications

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“…87 Cableless mobile and app based devices to monitor heart rate and rhythm during exercise have been piloted in children and are a credible alternative to laboratory testing. 88…”

Section: Exercise Assessmentmentioning

confidence: 99%

The adolescent athlete's heart; A miniature adult or grown‐up child?

Pieles

Stuart

2020

Clinical Cardiology

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The systematic development of early age talent in sports academies has led to the professionalization of pediatric sport and the sports physician need to be aware of pediatric cardiological problems. Research into the medical cardiac care and assessment of the pediatric athlete are accumulating, but specific pediatric international guidelines are not available yet and reference data for ECG and echocardiography are incomplete, in particular for the age group <12 years of age. This article is an introduction to the physiological and diagnostics specifics of the pediatric athlete. The focus lies in the differences in presentation and diagnosis between pediatric and adult athletes for the most common pathologies. Reference data for electrical and structural adaptations to intensive exercise are sparse particularly in athletes aged below 12 years old. Training related changes include decrease of resting heart rate, increase of cardiac output, ventricular cavity size, and wall thickness. Cardiac hypertrophy is less pronounced in pediatric athletes, as HR mediated cardiac output increase to endurance exercise is the dominant mechanism in peripubertal children. As in adults, the most pronounced cardiovascular adaptations appear in classical endurance sports like rowing, triathlon, and swimming, but the specifics of pediatric ECG and echocardiographic changes need to be considered.

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“…87 Cableless mobile and app based devices to monitor heart rate and rhythm during exercise have been piloted in children and are a credible alternative to laboratory testing. 88…”

Section: Exercise Assessmentmentioning

confidence: 99%

The adolescent athlete's heart; A miniature adult or grown‐up child?

Pieles

Stuart

2020

Clinical Cardiology

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“…arrhythmias). Cableless mobile and app-based devices are available for clinical use in children and early data on feasibility and diagnostic value are encouraging [52]. Mobile monitoring in the paediatric athlete should be used to investigate cardiac symptoms during exercise such as paroxysmal symptoms of palpitations, dizziness and syncope, postintervention (e.g.…”

Section: Mobile Monitoringmentioning

confidence: 99%

The Assessment of the Paediatric Athlete

Pieles

Oberhoffer²

2020

J. of Cardiovasc. Trans. Res.

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The success of systematic early age talent development has led to the professionalisation of youth sports academies used by clubs and governing bodies alike, and sports physicians are nowadays commonly confronted with paediatric cardiological problems. Medical cardiac care of the paediatric athlete is however in its infancy, and the international guidelines that are present for adult athletes, are not yet available. Similarly, reference data for ECG and echocardiography are incomplete. The aim of this article is to provide and introduction to the cardiac care of the paediatric athlete to facilitate healthy and above all, safe talent development, but also provide guidance on how to distinguish adaptive, beneficial cardiovascular remodelling from underlying pathology of congenital or inherited cardiovascular disease. Differences in presentation, diagnosis and treatment between childhood and adult athletes are highlighted and can educate the reader in the emerging field of paediatric sports cardiology.

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“…The device is supported for clinical use by a National Institute for Health and Care Excellence (NICE) technology appraisal [14] and was initially developed for detecting AF, for which the automatic diagnostic algorithm has excellent sensitivity (96.6%) and specificity (94%) for correctly interpreting AF versus normal sinus rhythm [15]. There have been several studies investigating the use of smartphone-based event recorders including AliveCor for population screening for AF in various settings [16][17][18][19][20][21] and feasibility for other rhythm disorders [3,[22][23][24]. Whilst AliveCor has now undergone assessment against conventional care for AF detection [25], it has yet to be assessed against standard care for the broader investigation of palpitations and arrhythmia assessment.…”

Section: Introductionmentioning

confidence: 99%

Multi-Centre Randomised Controlled Trial of a Smart Phone Based Event Recorder Alongside Standard Care Versus Standard Care for Patients Presenting to the Emergency Department with Palpitations and Pre-Syncope: The IPED (Investigation of Palpitations in the Ed) Study

et al. 2018

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Background: Patients with palpitations and pre-syncope commonly present to Emergency Departments (EDs) but underlying rhythm diagnosis is often not possible during the initial presentation. This trial compares the symptomatic rhythm detection rate of a smartphone-based event recorder (AliveCor) alongside standard care versus standard care alone, for participants presenting to the ED with palpitations and pre-syncope with no obvious cause evident at initial consultation. Methods: Multi-centre open label, randomised controlled trial. Participants ≥16 years old presenting to 10 UK hospital EDs were included. Participants were randomised to either (a) intervention group; standard care plus the use of a smartphone-based event recorder or (b) control group; standard care alone. Primary endpoint was symptomatic rhythm detection rate at 90 days. Trial registration number NCT02783898 (ClinicalTrials.gov). Findings: Two hundred forty-three participants were recruited over an 18-month period. A symptomatic rhythm was detected at 90 days in 69 (n = 124; 55.6%; 95% CI 46.9-64.4%) participants in the intervention group versus 11 (n = 116; 9.5%; 95% CI 4.2-14.8) in the control group (RR 5.9, 95% CI 3.3-10.5; p b 0.0001). Mean time to symptomatic rhythm detection in the intervention group was 9.5 days (SD 16.1, range 0-83) versus 42.9 days (SD 16.0, range 12-66; p b 0.0001) in the control group. The commonest symptomatic rhythms detected were sinus rhythm, sinus tachycardia and ectopic beats. A symptomatic cardiac arrhythmia was detected at 90 days in 11 (n = 124; 8.9%; 95% CI 3.9-13.9%) participants in the intervention group versus 1 (n = 116; 0.9%; 95% CI 0.0-2.5%) in the control group (RR 10.3, 95% CI 1.3-78.5; p = 0.006). Interpretation: Use of a smartphone-based event recorder increased the number of patients in whom an ECG was captured during symptoms over five-fold to more than 55% at 90 days. This safe, non-invasive and easy to use

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Comparison of a smartphone-based ECG recording system with a standard cardiac event monitor in the investigation of palpitations in children

Abstract: A smartphone-based event monitor allows simple, effective, long-term ECG event monitoring in children that is highly acceptable to the patient and parent.

Cited by 30 publications

References 13 publications

The adolescent athlete's heart; A miniature adult or grown‐up child?

The adolescent athlete's heart; A miniature adult or grown‐up child?

The Assessment of the Paediatric Athlete

Multi-Centre Randomised Controlled Trial of a Smart Phone Based Event Recorder Alongside Standard Care Versus Standard Care for Patients Presenting to the Emergency Department with Palpitations and Pre-Syncope: The IPED (Investigation of Palpitations in the Ed) Study

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