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Is 7-day event triggered ECG recording equivalent to 7-day Holter ECG recording for atrial fibrillation screening?
  1. Laurent Roten,
  2. Manuel Schilling,
  3. Andreas Häberlin,
  4. Jens Seiler,
  5. Nicola G Schwick,
  6. Jürg Fuhrer,
  7. Etienne Delacrétaz,
  8. Hildegard Tanner
  1. Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Switzerland
  1. Correspondence to Laurent Roten, Kardiologie, Inselspital, Freiburgstrasse, 3010 Bern, Switzerland; laurent.roten{at}


Objective Prolonged ECG monitoring is standard for atrial fibrillation (AF) screening. This study investigated whether 7-day event triggered (tECG) ECG recording is equivalent to 7-day continuous Holter (cECG) ECG recording for AF screening.

Design Both a cECG (Lifecard CF) and a tECG (R.Test Evolution 3) were simultaneously worn for 7 days by patients with known or suspected paroxysmal AF.

Results In 100 corresponding recordings, median effective duration of monitoring was 165 h (range 10–170 h) for cECG and 137 h (0–169 h) for tECG (p<0.001). Median number and total duration of arrhythmias (AF, atrial flutter or atrial tachycardia) of ≥30 s duration recorded by cECG were 10 (1–428) and 1030 min (≤1–10 020), respectively. An arrhythmia was recorded in 42 cECGs (42%) versus 37 tECGs (37%, p=0.56). Triggered ECG failed to record an arrhythmia in cECG positive cases because of interrupted monitoring in four cases and because of recording failure in one case. Sensitivity, specificity, and positive and negative predictive values of tECG therefore were 88%, 100%, 100%, and 92%, respectively. Quantitative cECG analysis required a median of 20 min (3–205 min) and qualitative tECG analysis 4 min (1–20 min; p<0.001). Skin irritation was a frequent side effect (42%) resulting in premature removal of devices in 16% of patients.

Conclusion Sensitivity of tECG for AF screening as compared to cECG is lower, mainly because of shorter effective monitoring duration. Qualitative tECG analysis is less time consuming than quantitative cECG analysis. Skin irritation is a frequent side effect and reason for premature device removal.

  • Atrial fibrillation
  • atrial flutter
  • Holter ECG
  • implantable cardioverter defibrillator (ICD)
  • sudden adult death syndrome
  • pacemakers
  • arrhythmias
  • invasive electrophysiology
  • atrial arrhythmias
  • rhythms
  • radiofrequency catheter ablation
  • ventricular tachycardia
  • atrial fibrillation, syncope
  • atrioventricular block

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  • Funding Dr Tanner was supported by a grant from the Swiss Foundation for Pacemaker and Electrophysiology.

  • Competing interests None.

  • Ethics approval Ethics approval was approved by Kantonale Ethikkommission Bern (

  • Provenance and peer review Not commissioned; externally peer reviewed.