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Atrial fibrillation detection with long-term continuous Holter ECG recording in patients with high cardiovascular
F Halimi1, P Sabouret2, J P Huberman3
1Hôpital Privé, Parly 2, 21 rue Moxouris, 78150, Le Chesnay, France.
Insights
Systematic 14-day ECG monitoring detected atrial fibrillation (AF) in 14% of high-risk patients with palpitations. This screening led to anticoagulation and antiarrhythmic therapy for most diagnosed patients.
Area of Science:
- Cardiology
- Medical Technology
Background:
- Atrial fibrillation (AF) poses significant cardiovascular risk, necessitating early detection in high-risk individuals.
- Continuous ECG monitoring offers advanced tools for identifying arrhythmias like AF.
Purpose of the Study:
- To evaluate the prevalence and management of AF in high-risk patients with palpitations using 14-day continuous ECG-Holter monitoring.
- To assess the diagnostic yield of systematic AF screening in this population.
Main Methods:
- Prospective enrollment of 336 high-risk patients (CHA2DS2-VASc score ≥2 for males, ≥3 for females) with palpitations and no prior documented arrhythmia.
- Utilized 14-day continuous Holter-ECG monitoring for arrhythmia detection.
Main Results:
- AF was detected in 14% of patients, with 23.4% diagnosed within the first 24 hours.
- Older age (≥65 years) and male gender were significantly associated with AF detection.
- Patients diagnosed with AF received anticoagulation (90%) and antiarrhythmic drugs (90%).
Conclusions:
- Systematic 14-day continuous ECG-Holter monitoring effectively screens for AF in high-risk patients with palpitations, yielding a 14% diagnostic rate.
- This screening strategy facilitates timely initiation of anticoagulation and antiarrhythmic therapies in newly diagnosed AF patients.
Aim:
New technologic tools for continuous ECG monitoring have been developed to detect and treat atrial fibrillation (AF) in specific populations with high cardiovascular risk. We evaluated the prevalence and the management of AF diagnosed in patients with high cardiovascular risk and non-documented clinical palpitation undergoing systematic 14-day continuous ECG-Holter monitoring.
Methods:
Patients were prospectively enrolled from December 2019 to December 2021 in this multicentre study, sponsored by the French National College of Cardiology. Patients met the following criteria: CHA2DS2VASc score ≥ 2 in males and ≥ 3 in females and clinical palpitations without previously documented arrhythmia. Enrolled patients underwent a continuous 14-day Holter-ECG monitoring for arrhythmia detection.
Results:
Among the 336 included patients, 39% were male, 75% were greater than 65 years of age and 46.5% had suffered a prior stroke. AF was detected in 14% of patients, among which 23.4% were detected in the first 24 h of monitoring. Finally, age ≥ 65 years (p = 0.037) was significantly associated with AF, as well as male gender (p = 0.023) and a lower rate of antiplatelet therapy (p = 0.018). Patients with diagnosed AF had a prescription of anticoagulation therapy in 90%. Antiarrhythmic drugs were administered in 90% of AF patients and 13% underwent AF ablation.
Conclusions:
The systematic AF screening of patients with palpitations and high cardiovascular risk resulted in a diagnostic yield of AF in 14% of the population with a 14-day continuous ECG-Holter monitor. This strategy resulted in the prescription of anticoagulation and antiarrhythmic therapy in 90% of the AF detected population.
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