Value of Extended Arrhythmia Screening in Adult Congenital Heart Disease Patients

Area of Science:

• Cardiology
• Medical Technology
• Electrophysiology

Background:

• European Society of Cardiology guidelines recommend arrhythmia and bradycardia screening for symptomatic adult congenital heart disease (ACHD) patients.
• Traditional methods include ambulatory Holter monitoring and implantable loop recorders (ILR).
• Emerging non-invasive technologies like smartwatches and smartphones offer extended ECG monitoring.

Purpose of the Study:

• To review the clinical utility of new non-invasive monitoring instruments for arrhythmias and bradycardias in ACHD patients.
• To assess if detected arrhythmias/bradycardias lead to clinically meaningful changes in patient care.
• To compare the diagnostic yield of various extended rhythm monitoring devices.

Main Methods:

• Narrative review of current literature on extended rhythm monitoring in ACHD.
• Discussion of cumulative Holter, 2-week continuous monitors, smartwatch/smartphone-based single-lead ECGs, and ILRs.
• Analysis of diagnostic yield and impact on clinical management.

Main Results:

• Extended rhythm monitoring demonstrates a high diagnostic yield, ranging from 18% (smartphone ECG) to 41% (ILR).
• New non-invasive technologies show potential as alternatives to conventional Holter or ILR.
• Clinically meaningful changes include medication adjustments, cardioversion, electrophysiology studies, ablation, or device implantation.

Conclusions:

• Contemporary arrhythmia screening in ACHD benefits from novel non-invasive technologies.
• These devices represent promising alternatives to Holter monitoring and ILR.
• Further head-to-head comparisons are needed to determine the optimal detection strategy.