Diagnostic Yield, Outcomes, and Resource Utilization With Different Ambulatory Electrocardiographic Monitoring
Nigel Gupta1, Jingrong Yang2, Kristi Reynolds3
1Department of Cardiac Electrophysiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
Insights
Longer arrhythmia monitoring with Zio XT patch or event monitor detects more atrial fibrillation/flutter than 24-hour Holter. Extended monitoring showed increased nonsustained ventricular tachycardia detection without adverse outcomes.
Area of Science:
- Cardiology
- Medical Devices
- Diagnostic Monitoring
Background:
- Accurate arrhythmia diagnosis is crucial for patient management.
- Longer monitoring duration can improve diagnostic yield but may delay diagnosis.
- Current ambulatory electrocardiographic monitoring strategies vary in duration and technology.
Purpose of the Study:
- To compare the diagnostic yield, clinical outcomes, and resource utilization of three arrhythmia monitoring strategies.
- To evaluate the effectiveness of a 14-day Zio XT patch, 24-hour Holter, and 30-day event monitor in detecting arrhythmias.
Main Methods:
- A matched cohort study of 330 adults without prior atrial fibrillation/flutter (AF/AFL).
- Patients received either a 14-day Zio XT patch, 24-hour Holter, or 30-day event monitor.
- Monitoring results, management changes, clinical outcomes, and resource utilization were assessed.
Main Results:
- The 14-day Zio XT patch detected AF/AFL in 6% of patients, compared to 0% with Holter (p=0.04) and 3% with event monitor (p=0.07).
- Nonsustained ventricular tachycardia was detected in 24% with Zio XT, versus 8% with Holter (p<0.001) and 4% with event monitor (p<0.001).
- No significant differences in outcomes or resource utilization were observed across monitoring strategies.
Conclusions:
- Prolonged monitoring (14-day Zio XT or 30-day event monitor) is superior to 24-hour Holter for detecting new AF/AFL.
- Zio XT showed higher detection of nonsustained ventricular tachycardia without increased adverse events.
- Personalized electrocardiographic monitoring strategies are needed to optimize clinical management.
Abstract:
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.
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