Is 7-day event triggered ECG recording equivalent to 7-day Holter ECG recording for atrial fibrillation screening?

Roten, Laurent; Schilling, Marianne; Häberlin, Andreas; Seiler, Jens; Schwick, Nicola; Fuhrer, Jürg; Delacrétaz, Etienne; Tanner, Hildegard

doi:10.1136/heartjnl-2011-301455

Cited by 41 publications

(25 citation statements)

References 18 publications

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“…7 To obtain the sensitivities of the various IRM strategies presented in this report, a 100% patient compliance is assumed; however, this is rarely the case in everyday clinical practice because even short-duration IRMs pose a significant compromise in the patients' quality of life, and this has been shown to lead to monitoring discontinuation. 7,20 Roten et al 20 recently showed that even with mediumduration IRM (7-day HM), 42% of patients complained of discomfort and skin irritation, whereas 16% discontinued the monitoring because of this reason. On the other hand, the implantation of leadless CM requires a minor surgical procedure, and the device itself may carry a risk of infection or patient discomfort.…”

Section: Judgment Of Therapeutic Success Based On Irmmentioning

confidence: 99%

A Comprehensive Evaluation of Rhythm Monitoring Strategies for the Detection of Atrial Fibrillation Recurrence

Charitos

Stierle²,

Ziegler³

et al. 2012

Circulation

169

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Background-Intermittent rhythm monitoring (IRM) to detect atrial fibrillation (AF) recurrence is employed to evaluate the success of therapeutic interventions. In a large population of patients with continuous monitoring (CM), we investigated the sensitivity of various frequencies and durations of IRM strategies on the detection of AF recurrence, the dynamics behind AF recurrence detection, and we describe measures to evaluate temporal AF recurrence. Methods and Results-Rhythm histories of 647 patients (mean AF burden, 0.12Ϯ0.22; median, 0.014; with implantable CM devices were reconstructed and analyzed. With the use of computationally intensive simulation, the sensitivity of IRM of various frequencies and durations on the identification of AF recurrence was evaluated. Prolonged-duration IRM was superior to shorter IRM (PϽ0.0001). However, even with aggressive IRM strategies, AF recurrence was not detected in a great proportion of patients. The temporal AF burden aggregation (AF density) was directly related to IRM sensitivity (PϽ0.0001). Even at similar AF burdens, patients with high-density AF required higher-frequency or prolonged-duration IRM to achieve the same sensitivity as in low-density AF (PϽ0.0001). Patients with high-density, low-burden AF benefit the most from CM for detection of AF recurrence. Conclusions-IRM follow-up is significantly inferior to CM. IRM strategies will not identify AF recurrence in a great proportion of patients at risk. Key Words: atrial fibrillation Ⅲ atrial fibrillation arrhythmia Ⅲ rhythm monitoring Ⅲ rhythm recorders D etection of atrial fibrillation (AF) recurrence after therapeutic interventions has until now been based primarily on the results of intermittent ("snapshot") rhythm monitoring (IRM). This approach has significant limitations in terms of sensitivity because the monitoring period of these examinations is limited; however, the results of these examinations are used to draw inferences on the success of ablation procedures or pharmacological strategies. It has been shown that reliance on symptoms or office ECGs overestimates the success rate of the ablation procedures and will misclassify patients who have recurrence of paroxysmal AF as being in sinus rhythm. [1][2][3][4] The current consensus on AF monitoring recommends at least two 24-hour Holter monitor (HM) examinations annually for the detection of AF recurrence after ablation procedures, 5-7 which, however, has also been shown to underdetect AF recurrence and thus overestimate procedural success. 1,8 Reliable and accurate detection of AF recurrence is thus of special importance for the evaluation of pharmacological or ablation therapies as well as when decisions on changes in anticoagulation or antiarrhythmic therapy are to be made. Editorial see p 791 Clinical Perspective on p 814With the introduction of implantable, leadless rhythm recorders, continuous monitoring (CM) has been proposed Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the qui...

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Section: Judgment Of Therapeutic Success Based On Irmmentioning

confidence: 99%

A Comprehensive Evaluation of Rhythm Monitoring Strategies for the Detection of Atrial Fibrillation Recurrence

Charitos

Stierle²,

Ziegler³

et al. 2012

Circulation

169

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“…2,4e7,8 In fact, low compliance has been noted in many lead-based extended ECG monitoring devices, including the Holter monitor, event monitors, and mobile cardiac outpatient telemetry. 10,11 In our study, although >1/ 2 the patients wore the patch for !1 week, only 1/3 of them wore the patch for 10 to 14 days. In part, this level of compliance can be attributed to the instructions given to patients: to wear the patch for up to 14 days or until symptoms were felt.…”

Section: Discussionmentioning

confidence: 95%

Diagnostic Yield of Patch Ambulatory Electrocardiogram Monitoring in Children (from a National Registry)

Bolourchi

Batra

2015

The American Journal of Cardiology

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“…In patients who do not have pacemakers or defibrillators who present with cryptogenic stroke, longer term ambulatory ECG monitoring using external or implantable devices may be worth considering to help confirm a diagnosis of subclinical AF 26 27. In a study of 100 patients being screened for AF, investigators compared the effectiveness of using 7-day triggered ECG monitoring with 7-day continuous Holter ECG monitoring for detection of AF 28. An arrhythmia was recorded in 42 subjects (42%) with continuous ECG recordings versus 37 subjects (32%) with triggered monitoring (p=0.56).…”

Section: Atrial Fibrillationmentioning

confidence: 99%

Almanac 2013: cardiac arrhythmias and pacing

Liew

2013

Heart

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Important advances have been made in the past few years in the fields of clinical cardiac electrophysiology and pacing. Researchers and clinicians have a greater understanding of the pathophysiological mechanisms underlying atrial fibrillation (AF), which has transpired into improved methods of detection, risk stratification, and treatments. The introduction of novel oral anticoagulants has provided clinicians with alternative options in managing patients with AF at moderate to high thromboembolic risk and further data has been emerging on the use of catheter ablation for the treatment of symptomatic AF. Another area of intense research in the field of cardiac arrhythmias and pacing is in the use of cardiac resynchronisation therapy (CRT) for the treatment of patients with heart failure. Following the publication of major landmark randomised controlled trials reporting that CRT confers a survival advantage in patients with severe heart failure and improves symptoms, many subsequent studies have been performed to further refine the selection of patients for CRT and determine the clinical characteristics associated with a favourable response. The field of sudden cardiac death and implantable cardioverter defibrillators also continues to be actively researched, with important new epidemiological and clinical data emerging on improved methods for patient selection, risk stratification, and management. This review covers the major recent advances in these areas related to cardiac arrhythmias and pacing.

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Is 7-day event triggered ECG recording equivalent to 7-day Holter ECG recording for atrial fibrillation screening?

Abstract: Sensitivity of tECG for AF screening as compared to cECG is lower, mainly because of shorter effective monitoring duration. Qualitative tECG analysis is less time consuming than quantitative cECG analysis. Skin irritation is a frequent side effect and reason for premature device removal.

Cited by 41 publications

References 18 publications

A Comprehensive Evaluation of Rhythm Monitoring Strategies for the Detection of Atrial Fibrillation Recurrence

A Comprehensive Evaluation of Rhythm Monitoring Strategies for the Detection of Atrial Fibrillation Recurrence

Diagnostic Yield of Patch Ambulatory Electrocardiogram Monitoring in Children (from a National Registry)

Almanac 2013: cardiac arrhythmias and pacing

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