Software‐based analysis of 1‐hour Holter ECG to select for prolonged ECG monitoring after stroke

Abstract

Objective: Identification of ischemic stroke patients at high risk for paroxysmal atrial fibrillation (pAF) during 72 hours Holter ECG might be useful to individualize the allocation of prolonged ECG monitoring times, currently not routinely applied in clinical practice. Methods: In a prospective multicenter study, the first analysable hour of raw ECG data from prolonged 72 hours Holter ECG monitoring in 1031 patients with acute ischemic stroke/TIA presenting in sinus rhythm was classified by an automated software (AA) into "no risk of AF" or "risk of AF" and compared to clinical variables to predict AF during 72 hours Holter-ECG. Results: pAF was diagnosed in 54 patients (5.2%; mean age: 78 years; female 56%) and was more frequently detected after 72 hours in patients classified by AA as "risk of AF" (n = 21, 17.8%) compared to "no risk of AF" (n = 33, 3.6%). AA-based risk stratification as "risk of AF" remained in the prediction model for pAF detection during 72 hours Holter ECG (OR3.814, 95% CI 2.024-7.816, P < 0.001), in addition to age (OR1.052, 95% CI 1.021-1.084, P = 0.001), NIHSS (OR 1.087, 95% CI 1.023-1.154, P = 0.007) and prior treatment with thrombolysis (OR2.639, 95% CI 1.313-5.306, P = 0.006). Similarly, risk stratification by AA significantly increased the area under the receiver operating characteristic curve (AUC) for prediction of pAF detection compared to a purely clinical risk score (AS5F alone: AUC 0.751; 95% CI 0.724-0.778; AUC for the combination: 0.789, 95% CI 0.763-0.814; difference between the AUC P = 0.022). Interpretation: Automated software-based ECG risk stratification selects patients with high risk of AF during 72 hours Holter ECG and adds predictive value to common clinical risk factors for AF prediction.

The diagnostic efficiency of artificial intelligence based 2 hours Holter monitoring in premature ventricular and supraventricular contractions detection

“…The 24 hours traditional Holter and 2 hours single-lead Holter tests are both electrocardiogram (ECG) monitoring tests that are used to diagnose arrhythmias; however, few studies have investigated the differences in accuracy and diagnostic efficiency between these two methods. 21 This study compared the aforementioned issues with a 24 h- improvements in the following aspects: (i) making the acquisition process more convenient and less intrusive. (ii) leads to the wider adoption of arrhythmia screening in primary healthcare settings.…”

“…Our research also found that ECG was ambiguous in the PSVC/PVC diagnosis and burden analysis (data not shown). The 24 hours traditional Holter and 2 hours single‐lead Holter tests are both electrocardiogram (ECG) monitoring tests that are used to diagnose arrhythmias; however, few studies have investigated the differences in accuracy and diagnostic efficiency between these two methods 21 . This study compared the aforementioned issues with a 24 h‐Holter and a 2 h‐Holter among patients requiring PSVC/PVC monitoring.…”

“…The 24 hours traditional Holter and 2 hours single‐lead Holter tests are both electrocardiogram (ECG) monitoring tests that are used to diagnose arrhythmias; however, few studies have investigated the differences in accuracy and diagnostic efficiency between these two methods. 21 This study compared the aforementioned issues with a 24 h‐Holter and a 2 h‐Holter among patients requiring PSVC/PVC monitoring. The principal findings of the study are as follows: (i) During the simultaneous use of both methods, they yielded the same PSVC/PVC diagnostic efficiency in 24 or 2 hours intervals.…”