Reliability of an external loop recorder for automatic recognition and transtelephonic ECG transmission of atrial fibrillation

Müller, A.; Scharner, W; Borchardt, Tilo; Och, Wolfgang; Korb, H.

doi:10.1258/jtt.2009.090402

Cited by 17 publications

(6 citation statements)

References 19 publications

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“…These findings support the discrepancy between perceived symptoms and documented arrhythmias, and confirm that silent AF is relatively frequent even in patients with history of palpitations. 4 , 5 , 16 , 17 …”

Section: Discussionmentioning

confidence: 99%

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External prolonged electrocardiogram monitoring in unexplained syncope and palpitations: results of the SYNARR-Flash study

et al. 2015

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AimsSYNARR-Flash study (Monitoring of SYNcopes and/or sustained palpitations of suspected ARRhythmic origin) is an international, multicentre, observational, prospective trial designed to evaluate the role of external 4-week electrocardiogram (ECG) monitoring in clinical work-up of unexplained syncope and/or sustained palpitations of suspected arrhythmic origin.Methods and resultsConsecutive patients were enrolled within 1 month after unexplained syncope or palpitations (index event) after being discharged from emergency room or hospitalization without a conclusive diagnosis. A 4-week ECG monitoring was obtained by external high-capacity loop recorder (SpiderFlash-T®, Sorin) storing patient-activated and auto-triggered tracings. Diagnostic monitorings included (i) conclusive events with reoccurrence of syncope or palpitation with concomitant ECG recording (with/without arrhythmias) and (ii) events with asymptomatic predefined significant arrhythmias (sustained supraventricular or ventricular tachycardia, advanced atrio-ventricular block, sinus bradycardia <30 b.p.m., pauses >6 s). SYNARR-Flash study enrolled 395 patients (57.7% females, 56.9 ± 18.7 years, 28.1% with syncope, and 71.9% with palpitations) from 10 European centres. For syncope, the 4-week diagnostic yield was 24.5%, and predictors of diagnostic events were early start of recording (0–15 vs. >15 days after index event) (OR 6.2, 95% CI 1.3–29.6, P = 0.021) and previous history of supraventricular arrhythmias (OR 3.6, 95% CI 1.4–9.7, P = 0.018). For palpitations, the 4-week diagnostic yield was 71.6% and predictors of diagnostic events were history of recurrent palpitations (P < 0.001) and early start of recording (P = 0.001).ConclusionThe 4-week external ECG monitoring can be considered as first-line tool in the diagnostic work-up of syncope and palpitation. Early recorder use, history of supraventricular arrhythmia, and frequent previous events increased the likelihood of diagnostic events during the 4-week external ECG monitoring.

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Section: Discussionmentioning

confidence: 99%

“… 15 External ECG recorders were also utilized to evaluate the burden of asymptomatic atrial fibrillation (AF), as in cryptogenic transient ischaemic attacks or after transcatheter ablation. 16 , 17 …”

Section: Introductionmentioning

confidence: 99%

External prolonged electrocardiogram monitoring in unexplained syncope and palpitations: results of the SYNARR-Flash study

et al. 2015

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“…after acute stroke, external or implantable event loop recorders or cardiac event recorders can also be used, over prolonged periods [10], [11]. While these devices are highly effective in detecting AF periods, a considerable proportion of them deliver false positive results, caused by supraventricular or ventricular extrasystoles and by sinus arrhythmias or sinoatrial blocks [12]. Further, if the recording is started by the patient in the presence of symptoms, the asymptomatic episodes will go undetected.…”

Section: Introductionmentioning

confidence: 99%

Improved Detection of Paroxysmal Atrial Fibrillation Utilizing a Software-Assisted Electrocardiogram Approach

Schaefer

Leussler²,

Rosin

et al. 2014

PLoS ONE

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BackgroundAutomated complexity-based statistical stroke risk analysis (SRA) of electrocardiogram (ECG) recordings can be used to estimate the risk of paroxysmal atrial fibrillation (pAF). We investigated whether this method could improve the reliability of detection of patients at risk for pAF.Methods and ResultsData from 12-lead ECGs, 24-h Holter ECGs, and SRA based on separate 1-hour Holter ECG snips were collected from three groups: 70 patients with a history of pAF but who showed no AF episode in the 12-lead ECG at study entry; 19 patients with chronic AF (at study entry); and 100 young healthy individuals. AF episodes were detected by Holter ECG in 19 of the 70 non-chronic AF patients (27.1% overall, 18.6% in the first hour), and 37 of these 70 patients were classified as at risk for pAF by SRA (representing a sensitivity of 52.9% based on the first hour of analyzed recording). Fifty-four of the 70 patients also showed a sinus rhythm in the first hour. SRA detected pAF risk in 23 of these 54 patients (representing a sensitivity of 42.6%). The Holter data showed at least 1 AF episode and at least 1 hour of sinus rhythm in nine of the patients with pAF. For these patients, SRA classified 77.8% as being at risk in the first hour after the end of the AF episode, and 71.4% and 42.9% as being at risk in the second and third hours, respectively. SRA detected almost all cardiologist-confirmed AF episodes that had been recorded in 1-hour ECG snips (sensitivity, 99.2%; specificity, 99.2%).ConclusionsThis outpatient study confirms previous findings that routine use of SRA could improve AF detection rates and thus may shorten the time between AF onset and initiation of prevention measures for patients at high risk for stroke.

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“…Antiarrhythmic drugs were withdrawn after a stabilisation period of 90 days after the initial procedure and post-procedural experienced AF burden. Prior to the outpatient clinic visits at 3, 6 and 12 months, a 7-day auto-triggered event recording was performed using a Vitaphone recorder (Vitaphone GmbH, Mannheim, Germany) [19, 20]. An episode of AF is defined as an episode of at least 30 s’ duration.…”

Section: Methodsmentioning

confidence: 99%

Use of three-dimensional computed tomography overlay for real-time cryoballoon ablation in atrial fibrillation reduces radiation dose and contrast dye

et al. 2017

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AimsCryoballoon pulmonary vein (PV) isolation in patients with atrial fibrillation has proven to be effective in short-term and long-term follow-up. To visualise the PV anatomy, pre-ablation contrast pulmonary venography is commonly performed. Three-dimensional (3D) computed tomography (CT) overlay is a new technique creating a live 3D image of the left atrium by integrating a previously obtained CT scan during fluoroscopy. To evaluate the benefits of 3D CT overlay during cryoballoon ablation, we studied the use of 3D CT overlay versus contrast pulmonary venography in a randomised fashion in patients with paroxysmal atrial fibrillation undergoing cryoballoon PV isolation.Methods and resultsBetween October 2012 and June 2013, 30 patients accepted for PV isolation were randomised to cryoballoon PV isolation using either 3D CT overlay or contrast pulmonary venography. All patients underwent a pre-procedural cardiac CT for evaluation of the anatomy of the left atrium (LA) and the PVs. In the 3D CT overlay group, a 3D reconstruction of the LA and PVs was made. An overlay of the CT reconstruction was then projected over live fluoroscopy. Patients in the contrast pulmonary venography group received significantly more contrast agent (77.1 ± 21.2 cc vs 40.1 ± 17.6 cc, p < 0.001) and radiation (43.0 ± 21.9 Gy.cm2 vs 28.41 ± 11.7 Gy.cm2, p = 0.04) than subjects in the 3D CT overlay group. There was no difference in total procedure time, fluoroscopy time and the amount of cryoapplications between the two groups.ConclusionThe use of 3D CT overlay decreases radiation and contrast dye exposure and can assist in guiding cryoballoon-based PV isolation.

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Reliability of an external loop recorder for automatic recognition and transtelephonic ECG transmission of atrial fibrillation

Cited by 17 publications

References 19 publications

External prolonged electrocardiogram monitoring in unexplained syncope and palpitations: results of the SYNARR-Flash study

External prolonged electrocardiogram monitoring in unexplained syncope and palpitations: results of the SYNARR-Flash study

Improved Detection of Paroxysmal Atrial Fibrillation Utilizing a Software-Assisted Electrocardiogram Approach

Use of three-dimensional computed tomography overlay for real-time cryoballoon ablation in atrial fibrillation reduces radiation dose and contrast dye

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