Diagnostic yield is dependent on monitoring duration. Insights from a full-disclosure mobile cardiac telemetry system

Abstract

Background: Despite the advancement of electrocardiogram (ECG) monitoring methods, the most important factor influencing diagnostic yield (DY) may still be monitoring duration. Ambulatory ECG monitoring, typically with 24-48 hours duration, is widely used but may result in underdiagnosis of rare arrhythmias.Aims: This study aimed to examine the relationship between the DY and monitoring duration in a large patient cohort and investigate sex and age differences in the presentation of arrhythmias. Methods:The study population consisted of 25 151 patients (57.8% women; median [interquartile range, IQR], 71 [64-78] years), who were examined with mobile cardiac telemetry during 2017 in the United States, using the PocketECG TM that continuously transmits a signal on a beat-to-beat basis. We investigated the occurrence of atrial fibrillation at a burden of both ≤1% (atrial fibrillation [AF], ≤1%) and ≤10% (AF ≤10%), premature ventricular contractions (PVC; >10 000 per 24 hours), non-sustained ventricular tachycardias (nsVT), sustained ventricular tachycardias (VT ≥30 seconds), atrioventricular blocks (AVB), pauses of >3 seconds duration, and bradycardia (heart rate <40 beats per minute for ≥60 seconds). Results:The median (IQR) recording duration was 15.4, 8.2-28.2) days. The DY increased gradually with monitoring duration for all types of investigated arrhythmias. Compared to DY after up to 30 days of monitoring, a standard 24 hours monitoring resulted in DY for males/females of 20%/18% for AF ≤1%, 29%/28% for AF ≤10%, 45%/40% for PVCs, 17%/11% for nsVT, 17%/11% for VT ≥30 seconds, 49%/42 for AVB, 27%/20% for pauses, 36%/29% for bradycardia. Conclusion:A substantial number of patients suffering from arrhythmias may remain undiagnosed due to insufficient ECG monitoring time.

Evaluation of premature ventricular complexes during in‐hospital ECG monitoring as a predictor of ventricular tachycardia in an intensive care unit cohort

“…In addition, in our analysis, we used a 24‐h time period to examine the association of PVCs and VT based on prior studies that examined IHCA (Do et al, 2015, 2019). Different analytical approaches, such as the diagnostic yield proposed by Dziubiński et al (2022), might be useful for future studies.…”

“…Different analytical approaches, such as the diagnostic yield proposed by Dziubiński et al (2022), might be useful for future studies.…”

Can 24 h of ambulatory ECG be used to triage patients to extended monitoring?

“…Monitoring durations for AF detection vary widely, from single‐day full disclosure Holter ECGs to several years of intermittent recordings using implantable devices. The diagnostic yield depends on recording quality and duration (Dziubinski et al, 2021), but longer recordings are associated with higher costs, as well as with potential discomfort to the patient, and access to long‐term ECG monitoring is limited by some insurance providers.…”

Ventricular tachycardia risk prediction with an abbreviated duration mobile cardiac telemetry

“…Mobile cardiac telemetry (MCT) recordings are indicated as part of the diagnostic workup for a diverse range of symptoms, including chest palpitations, syncope, and near syncope. 9 The optimal monitoring duration for these indications remains unknown; while short recording durations imply a risk of underdetection of significant arrhythmias, 10 longer recordings are associated with increased cost and patient discomfort as well as incidental detection of arrythmias without clinical relevance. 10 , 11 Currently, data collected during short MCT recordings are not used to inform the need for extended or repeated monitoring, but a computer-derived risk score could be used by physicians to triage patients to shorter or longer monitoring durations depending on the clinical situation.…”