Monitoring Duration vs Diagnostic Yield in Patients with Paroxysmal Atrial Fibrillation
Optimizing the Duration of Monitoring with the Diagnostic Yield for Bradyaarhythmia
Micro-Atrial Fibrillation Episodes Are Usually Followed by Clinical Atrial Fibrillation
Monitoring Duration vs Diagnostic Yield in Patients with Paroxysmal Atrial Fibrillation
Research presented at the 2018 Heart Rhythm Scientific Sessions showed that online monitoring with PocketECG may lead to more timely and accurate diagnosis of Paroxysmal Atrial Fibrillation (PAF) over other methods including the Holter and multi-day patch.
Key Research Findings:
- PocketECG allows for better detection of PAF – 36% over the multi-day patch
- The ability to flexibly extend monitoring duration increased diagnostic yield
- Online monitoring reduces the time to diagnosis
As illustrated in the bar graph, online monitoring improves diagnostic yield more than any other monitoring approach, including the 24-and 48-hour Holter and the offline multi-day patch.
Optimizing the Duration of Monitoring with the Diagnostic Yield for Bradyaarhythmia
The research presented at American College of Cardiology 2019 Scientific Sessions indicates that optimizing monitoring duration increases diagnostic yield for Bradyarrhythmia. The ability to prolong the monitoring duration up to 30 days allows to significantly increase the diagnostic yield over shorter monitoring methods. Early detection of Bradycardia can, in turn, result in earlier treatment, which may include pacemaker implantation.
Bradyarrhythmia, including unusually slow heart rate (bradycardia < 40 BPM), or blocked heart beats (2nd and 3rd degree atrioventricular blocks) and pauses, carries a significant risk of sudden cardiac death. While guidelines currently recommend the use of cardiac monitoring to evaluate patients who present with an abnormally slow heart rate, this research suggests that short-term monitoring may not be sufficient to accurately diagnose some patients, who may require an implantable pacemaker to regulate their heart rhythm.
The retrospective study analyzed 26,567 diagnostic summary reports from full-disclosure telemetry tests recorded between Jan. 1, and Dec. 31, 2017 by US-based Medi-Lynx Cardiac Monitoring. Researchers identified 3,325 cases of bradyarrhythmia using the full-disclosure PocketECG device.
The DY of bradyarrhythmia for continuous full-disclosure MCT monitoring for up to 30 days was:
- 175% higher than 24 hours of continuous monitoring (Holter)
- 37% higher than 7 days of continuous monitoring (Holter)
- 19% higher than 11 days of continuous monitoring (Patch)
Of the reports analyzed:
- 618 patients were diagnosed with 2nd or 3rd degree atrioventricular block,
- 1,223 patients diagnosed with pause > 3s,
- 1,997 patients with bradycardia < 40 BPM.
Micro-Atrial Fibrillation Episodes Are Usually Followed by Clinical Atrial Fibrillation
The new study presented at the 2019 Heart Rhythm Society Annual Scientific Sessions not only strengthened the link between micro-AF and clinical AF but also found that the probability of an episode of clinical AF occurring within 72 hours after detecting micro-AF was very high (82%). Using one year of data, researchers evaluated cardiac telemetry reports from 26,567 people in the United States (42% men, median age 71 years) who recorded a long-term ECG (up to 30 days) with the PocketECG full disclosure mobile cardiac telemetry device.
Current guidelines define atrial fibrillation (AF) as a ⩾30s episode of irregular cardiac rhythm without p-waves. As the disease progresses, the duration of AF episodes becomes longer and longer, and the impact on patient’s health increases as well. The objective of the research was to study association between micro-AF episodes (4 beats – 29s) and clinical AF in subjects with up to 30-day PocketECG device full-disclosure telemetry monitoring.
The research has the potential to underline how significant it is to recognize short episodes of arrhythmia, such as Micro-AF, in order to prevent it from turning into clinically classified atrial fibrillation, a heart disease which can lead to stroke.
The study shows either micro-AF or clinical AF was identified in 17% of all patients (4610 patients). Roughly half of these patients (2 327) had only clinical AF, 9% had only micro-AF and 41% had episodes of both micro-AF and clinical AF.
82.7% of patients diagnosed with micro-AF also experienced at least one episode of clinical AF. The study indicates a very high probability (82%) of clinical AF following an episode of micro-AF.
In fact, 74% of all patients who experienced an episode of micro-AF also experienced clinical AF within the next 72 hours.
The probability of capturing Clinical AF after an episode of micro-AF varies in age and gender groups, however in all these groups micro-AF were very likely to be followed by clinical AF.
