Single-lead portable ECG devices: Perceptions and clinical accuracy compared to conventional cardiac monitoring

Portable ECG devices are widely available yet there are limited data on their accuracy, physician and patient perceptions, and ease of use. The purpose of this study was to evaluate the accuracy of 4 single-lead portable ECG devices compared to a conventional 3-lead hospital cardiac monitor and to assess physician and patient perceptions of portable ECG devices.

Twenty consecutive hospitalized patients were provided 4 portable ECG devices for 30 second cardiac rhythm recording. ECG rhythm strips from the portable ECG devices were interpreted by a group of 5 physician reviewers. The reviewers then compared the portable ECG device rhythm strips to simultaneously recorded hospital cardiac monitor rhythm strips to determine physician preference. A cardiac electrophysiologist interpreted ECG rhythm strips from the hospital cardiac monitor as the "gold standard." Rhythm interpretations of the portable ECG devices and the hospital cardiac monitor were analyzed to evaluate clinical accuracy. Patient perceptions were evaluated by a 20-item questionnaire.

There was less than 50% concordance of portable ECG device rhythm strips with the hospital cardiac monitor (when uninterpretable rhythm strips were included). Physicians usually preferred interpreting ECGs from hospital cardiac monitors compared to portable ECG devices. Manufacturer instructions were insufficient to allow patients to operate portable ECG devices in a limited time. Most patients felt comfortable using a portable ECG device if prescribed by a physician.

Portable ECG devices may be a reasonable option for long-term rhythm surveillance in select patients. Widespread use of these devices cannot be endorsed unless improvements in their accuracy are properly addressed.