Diagnostic Yield, Outcomes, and Resource Utilization With Different Ambulatory Electrocardiographic Monitoring Strategies

https://doi.org/10.1016/j.amjcard.2021.11.027Get rights and content

Accurate diagnosis of arrhythmias is improved with longer monitoring duration but can risk delayed diagnosis. We compared diagnostic yield, outcomes, and resource utilization by arrhythmia monitoring strategy in 330 matched adults (mean age 64 years, 40% women, and 30% non-White) without previously documented atrial fibrillation or atrial flutter (AF/AFL) who received ambulatory electrocardiographic monitoring by 14-day Zio XT (patch-based continuous monitor), 24-hour Holter, or 30-day event monitor (external loop recorder) between October 2011 and May 2014. Patients were matched by age, gender, site, likelihood of receiving Zio XT patch, and indication for monitoring, and subsequently followed for monitoring results, management changes, clinical outcomes, and resource utilization. AF/AFL ≥30 seconds was noted in 6% receiving Zio XT versus 0% by Holter (p = 0.04) and 3% by event monitor (p = 0.07). Nonsustained ventricular tachycardia was noted in 24% for Zio XT patch versus 8% (p <0.001) for Holter and 4% (p <0.001) for event monitor. No significant differences between monitoring strategies in outcomes or resource utilization were observed. Prolonged monitoring with 14-day Zio XT patch or 30-day event monitor was superior to 24-hour Holter in detecting new AF/AFL but not different from each other. Documented nonsustained ventricular tachycardia was more frequent with Zio XT than 24-hour Holter and 30-day event monitor without apparent increased risk of adverse outcomes or excess utilization. In conclusion, additional efforts are needed to further personalize electrocardiographic monitoring strategies that optimize clinical management and outcomes.

Section snippets

Disclosures

The authors have no conflicts of interest to declare.

References (18)

  • JS Steinberg et al.

    2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry

    Heart Rhythm

    (2017)
  • T Sanna et al.

    Cryptogenic stroke and underlying atrial fibrillation

    N Engl J Med

    (2014)
  • DJ Gladstone et al.

    EMBRACE Investigators and Coordinators. Atrial fibrillation in patients with cryptogenic stroke

    N Engl J Med

    (2014)
  • MD Solomon et al.

    Incidence and timing of potentially high-risk arrhythmias detected through long term continuous ambulatory electrocardiographic monitoring

    BMC Cardiovasc Disord

    (2016)
  • N. Krieger

    Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology

    Am J Public Health

    (1992)
  • Gordon NP. Characteristics of adult health plan members in the Northern California Region Membership, as estimated from...
  • C Koebnick et al.

    Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data

    Perm J

    (2012)
  • AS Go et al.

    Association of burden of atrial fibrillation with risk of ischemic stroke in adults with paroxysmal atrial fibrillation: the KP-RHYTHM study

    JAMA Cardiol

    (2018)
  • PM Barrett et al.

    Comparison of 24-hour Holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring

    Am J Med

    (2014)
There are more references available in the full text version of this article.

Cited by (2)

  • A Review on Atrial Fibrillation Detection From Ambulatory ECG

    2024, IEEE Transactions on Biomedical Engineering

This study was supported by a research grant from iRhythm Technologies, Inc.

Dr. Go has received research funding through his institution from Bristol Myers Squibb; iRhythm Technologies, Inc.; the National Institute of Diabetes and Digestive and Kidney Diseases; and the National Heart, Lung, and Blood Institute. Dr. Reynolds has received research funding through her institution from iRhythm Technologies, Inc. Ms. Lenane is an employee of iRhythm Technologies, Inc. Dr. Solomon has received research funding through his institution from iRhythm Technologies, Inc.

View full text