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Published on: December 11, 2019
An implantable loop recorder or smartphone based single-lead electrocardiogram to detect arrhythmia in adults with
Maarten A Koole1,2,3, Dirkjan Kauw4, Kirsten M Kooiman1
1Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Insights
Smartphone ECG monitoring is a viable alternative to implantable loop recorders for detecting arrhythmias in adult congenital heart disease (ACHD) patients. This non-invasive method offers comparable diagnostic yield and supports management decisions.
Area of Science:
- Cardiology
- Medical Technology
- Electrophysiology
Background:
- European Society of Cardiology (ESC) guidelines recommend arrhythmia screening for adult congenital heart disease (ACHD) patients at risk.
- The optimal method for detecting these arrhythmic events remains undetermined.
Purpose of the Study:
- To compare the diagnostic yield and clinical utility of smartphone-based single-lead electrocardiogram (ECG) monitoring versus implantable loop recorders (ILRs) in symptomatic ACHD patients.
Main Methods:
- A study involving 116 symptomatic ACHD patients, comparing those who received an ILR (n=23) with those using smartphone-based ECG (n=93).
- Data collected included baseline characteristics, monitoring duration, and time to first detected arrhythmia.
- Primary endpoint was time to first detected arrhythmia.
Main Results:
- No significant difference in the median time to the first arrhythmia between ILR and smartphone ECG groups (3 months).
- Atrial fibrillation was the most frequent arrhythmia detected (n=16).
- Management decisions, including medication changes and device implantation, were made based on findings in both groups.
Conclusions:
- Smartphone-based single-lead ECG monitoring is a safe and effective non-invasive alternative to ILR implantation for arrhythmia detection in symptomatic ACHD patients.
- This approach is particularly suitable for patients without syncope, offering comparable diagnostic yield and influencing management decisions.
Background:
The European Society of Cardiology (ESC) guidelines for the management of adult congenital heart disease (ACHD) recommend screening in patients at risk for arrhythmic events. However, the optimal mode of detection is unknown.
Methods:
Baseline and follow-up data of symptomatic ACHD patients who received an implantable loop recorder (ILR) or who participated in a smartphone based single-lead electrocardiogram study were collected. The primary endpoint was time to first detected arrhythmia.
Results:
In total 116 ACHD patients (mean age 42 years, 44% male) were studied. The ILR group (n = 23) differed from the smartphone based single-lead electrocardiogram group (n = 93) in having a greater part of males and had more severe CHD and (near) syncope as qualifying diagnosis. In the smartphone based single-lead electrocardiogram group history of arrhythmia and palpitations were more frequent (all p < 0.05). Monitoring was performed for 40 and 79 patient-years for the ILR- and smartphone based single-lead electrocardiogram group, respectively. Arrhythmias occurred in 33 patients with an equal median time for both groups to first arrhythmia of 3 months (HR of 0.7, p = 0.81). Furthermore, atrial fibrillation occurred most often (n = 16) and common therapy changes included medication changes (n = 7) and implantation of pacemaker or Implantable Cardioverter Defibrillator (ICD) (N = 4). Symptoms or mode of detection were not a determinant of the first event.
Conclusion:
Non-invasive smartphone based single-lead electrocardiogram monitoring could be an acceptable alternative for ILR implantation in detecting arrhythmia in symptomatic ACHD patients in respect to diagnostic yield, safety and management decisions, especially in those without syncope.
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