Symptom-Triggered 6-Lead ECG Monitoring Significantly Increases Arrhythmia Detection Beyond Traditional Ambulatory...

Patients with palpitations and dizziness are typically monitored using ambulatory electrocardiographic (ECG) monitoring including Holter monitors and extended continuous ECG monitors. The KardiaMobile 6L (KM6L), a portable medical-grade ECG recorder, enables patients to initiate 6-lead ECG recordings during symptoms when needed.

This study aimed to assess the comparative effectiveness in detecting clinically significant arrhythmias between ambulatory ECG monitoring modalities and 30-day use of KM6L.

Patients with palpitations or other arrhythmic symptoms who were referred to for standard ambulatory monitoring (either 24- or 48-hour Holter or ambulatory ECG patch) were asked to perform 1-minute, 6-lead ECG recordings with the KM6L device during symptomatic episodes over a 30-day period. Clinically significant arrhythmias were defined as atrial fibrillation/flutter, second/third-degree atrioventricular block, wide complex tachycardia, supraventricular tachycardia >100 bpm, pauses >3 seconds, or sinus tachycardia >130 bpm. Detection rates between KM6L and standard monitoring were compared using McNemar test.

We enrolled 350 (40%, n = 140 with 24/48-hour Holter) patients who recorded 6,251 KM6L recordings (median 15 per patient). Significant arrhythmias were detected in 66 patients (18.9%) using either ambulatory ECG monitoring or KM6L. Ambulatory ECG monitoring modalities identified arrhythmias in 27 patients (7.7%), whereas KM6L detected arrhythmias in 52 patients (14.9%) (P < 0.001). Importantly, 39 arrhythmia episodes (11.1%) were detected exclusively by KM6L (P = 0.0008), most commonly atrial fibrillation (n = 23).

These findings demonstrate that patient-initiated, symptom-triggered ECG monitoring substantially enhances arrhythmia detection compared with traditional short-duration monitoring.