Purpose Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Paroxysmal AF (PAF) comprises approximately half of AF cases and poses an equivalent risk of thromboembolism to other AF sub-types. However, PAF poses a particular diagnostic challenge given its variable frequency, potential brevity and frequent lack of symptoms. Currently, no definitive method to identify PAF has been proposed although 24-hour or 1-week rhythm monitoring remain common practice. We aim to determine whether the longer-term, intermittent use of a handheld ECG monitor is an effective investigational tool to improve the diagnosis of PAF in a targeted population.
Methods Patients meeting the following criteria were entered into the study: suspected paroxysmal atrial arrhythmia (defined as palpitations or detection of an irregular pulse); aged 40 years and over; no previously documented atrial arrhythmia; sinus rhythm confirmed with a 12-lead ECG; no significant electrolyte disturbance. Participants were issued with an automated cardiac event recorder for 1-week, deemed standard practice (R Test Evolution 4, Novacor). They also used a handheld ECG monitor (OMRON Portable ECG Monitor HCG-801), recording 30-second segments twice-daily and with relevant symptoms, for a 12-week period. Recordings were analysed by a blinded cardiologist.
Results We recruited 110 consecutive eligible participants (mean age 66 years; 70% female). 84% were referred with palpitations and 16% with an irregular pulse. 90% of participants completed the study and 99% of recordings were suitable for analysis. Atrial arrhythmias were detected in 29 patients (26%). Of these 23 were diagnosed with PAF, 5 with atrial flutter and 1 with atrial tachycardia. This group had a mean CHA2DS2VASc score of 2.1. 31% of cases were identified using the standard device, 41% using the handheld ECG monitor (p = 0.72) and 28% with both devices. A significantly greater number of atrial arrhythmias were detected over a 12-week monitoring period as compared to both a 24-hour (n = 29 vs 5, p = 0.0001) and 1-week monitoring period (n = 29 vs 17, p = 0.03); see Figure 1.
Conclusions The intermittent use of a handheld ECG monitor over 12-weeks significantly increases the diagnostic yield of PAF when compared to standard investigation. Our findings suggest that the duration of cardiac monitoring used in current practice should be extended.
- Paroxysmal atrial fibrillaton
- Stroke prevention
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