Comparison of Quality of Ambulatory Electrocardiograms Obtained Using Novel Wireless ‘Android App’ Based Webcardio System and Conventional Holter

Abstract

BACKGROUND Ambulatory electrocardiogram (AECG) is done when cardiac arrhythmia is suspected. The conventional method of AECG recording uses 24 hour Holter. WebCardio using WiPatch is a new AECG system which can record for 72 hours. Since it is new and the WiPatch is placed in the left upper part of chest, the quality of the ECG especially that of P wave needs to be evaluated. METHODS The study compared the quality of AECG of wireless Android App based WebCardio system with the AECG of conventional Holter by simultaneously connecting both for 24 hours in patients having indication for AECG. The study was done in the department of cardiology, Medical College, Thrissur. The quality of P and QRS were compared at specific time periods of AECG, in the events and arrhythmias picked by AECG system and by scanning the entire AECG page by page. Periods of artefacts and no recording were evaluated. System generated events, maximum heart rate, minimum heart rate and longest RR interval were compared in both recordings. RESULTS 141 patients had simultaneous recordings by both systems of AECG. Overall quality of AECG was better with the WebCardio compared to Holter (138 Vs 125, p=0.001). Quality of P wave was better in the WebCardio than Holter (135 Vs 122, p=0.002) whereas quality of QRS was similar. The occurrence of artefacts lasting for more than 30 seconds was more in Holter compared to WebCardio (40 Vs 26, p=0.065), and no-recording lasting for more than 30 seconds were similar in the Holter and WebCardio (11 vs. 13). The maximum heart rate, minimum heart rate and longest RR interval were correctly identified in higher number of cases by WebCardio than the Holter (136 vs. 131, 139 vs. 138, 137 vs. 133 respectively), though statistically not different. CONCLUSIONS The study showed that the overall quality of 24 hour AECG recording was better in the WebCardio compared to Holter. This difference was due to the better quality of P in the WebCardio. Ambulatory ECG with WebCardio systems is a good alternative to conventional Holter.

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“…The whole recording was available online for review by the treating physician. This FDA-approved device has been found to be comparable if not superior to the standard Holter in terms of electrogram quality and arrhythmia detection [ 9 , 10 ].…”