Atrial fibrillation detection using single lead portable electrocardiographic monitoring: a systematic review and meta-analysis

Abstract

ObjectivesRecent technology advances have allowed for heart rhythm monitoring using single-lead ECG monitoring devices, which can be used for early diagnosis of atrial fibrillation (AF). We sought to investigate the AF detection rate using portable ECG devices compared with Holter monitoring.Setting, participants and outcome measuresWe searched the Medline, Embase and Scopus databases (conducted on 8 May 2017) using search terms related to AF screening and included studies with adults aged >18 years using portable ECG devices or Holter monitoring for AF detection. We excluded studies using implantable loop recorders and pacemakers. Using a random-effects model we calculated the overall AF detection rate. Meta-regression analysis was performed to explore potential sources for heterogeneity. Quality of reporting was assessed using the tool developed by Downs and Black.ResultsPortable ECG monitoring was used in 18 studies (n=117 436) and Holter monitoring was used in 36 studies (n=8498). The AF detection rate using portable ECG monitoring was 1.7% (95% CI 1.4 to 2.1), with significant heterogeneity between studies (p<0.001). There was a moderate linear relationship between total monitoring time and AF detection rate (r=0.65, p=0.003), and meta-regression identified total monitoring time (p=0.005) and body mass index (p=0.01) as potential contributors to heterogeneity. The detection rate (4.8%, 95% CI 3.6% to 6.0%) in eight studies (n=10 199), which performed multiple ECG recordings was comparable to that with 24 hours Holter (4.6%, 95% CI 3.5% to 5.7%). Intermittent recordings for 19 min total produced similar AF detection to 24 hours Holter monitoring.ConclusionPortable ECG devices may offer an efficient screening option for AF compared with 24 hours Holter monitoring.PROSPERO registration numberCRD42017061021.

Cardiac arrhythmia detection outcomes among patients monitored with the Zio patch system: a systematic literature review

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Diagnostic Accuracy of a Smartphone-Operated, Single-Lead Electrocardiography Device for Detection of Rhythm and Conduction Abnormalities in Primary Care

“…8 One such device, the KardiaMobile, is a smartphone-connected, single-lead ECG (1L-ECG) device. 9,10 Smartphoneoperated ECG has been studied for screening purposes and has shown great promise. 11 A recent report issued by the United Kingdom's National Health Service expects the device to be highly cost saving in the context of primary care.…”

Improving the quality of care for patients with or at risk of atrial fibrillation: an improvement initiative in UK general practices

“…A small proportion of patients with an AF diagnosis are still on aspirin monotherapy despite guideline recommendations against its prescription for stroke prevention in patients diagnosed with AF 10. This may be due to patient preferences or aspirin monotherapy prescription for another comorbidity, but also suggests that further work needs to be undertaken around this.…”

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