Does a Smartphone-Based ECG Recording System in Pediatric Patients With Palpitations Improve Diagnostic Yield?

Palpitations in children are common and obtaining symptom-rhythm correlation is diagnostic, but challenging to obtain. The AliveCor KardiaMobile monitor is a smartphone-based single-lead ECG event recorder with limited study in children. We compared using this smartphone recorder to a conventional (Cardiocall) event recorder.

We performed a prospective, randomized study of children presenting to pediatric cardiology for investigation of palpitations who require an event recorder for symptom-rhythm correlation. Patients were randomized to the smartphone or conventional recorder for rhythm documentation for 3 months or 4 weeks, respectively. Diagnostic tracings were defined as one pathologic arrhythmia or three sinus rhythm tracings. We assessed tracing quality, diagnoses obtained, and time to diagnosis between groups. Patients were surveyed to assess perceptions of using the devices.

One hundred participants were enrolled and randomized to 50 in each group. Diagnostic tracings were achieved in 51% versus 44% (p = 0.525) in the smartphone versus conventional group at means of 23.7 (SD 36.4) versus 11.5 (SD 15.2) days, p = 0.181. Participants who used the smartphone monitor were more likely to transmit recordings (70% vs. 49%, p = 0.037) and more often willing to use the device again (87% vs. 42%, p = 0.015), with no differences between groups in finding episodes easy to record (74% vs. 100%, p = 0.15), easy to transmit (70% vs. 46%, p = 0.26), or overall satisfaction (83% vs. 58%, p = 0.13).

Smartphone monitor devices provided similar diagnostic yield to conventional monitors in children. Families who used the smartphone monitor were more willing to use the device again.