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

Abstract

Objective: Cardiac arrhythmias can be serious and life threatening, and can impose a significant burden on healthcare systems. Recent technological advances in ambulatory electrocardiogram recorders have led to the development of unobtrusive wearable biosensors which allow physicians to study patients' continuous cardiac rhythm data collected over multiple weeks. The objective of this systematic literature review was to summarize evidence on the clinical effectiveness of the Zio 1 patch, a long-term, continuous, uninterrupted cardiac monitoring system. Methods: Findings from searches of MEDLINE, Embase and the Cochrane Central Register of Controlled Trials, as well as grey literature, were screened by two reviewers to identify studies reporting cardiac arrhythmia detection outcomes among patients monitored with Zio for an intended duration 7 days. Results: Twenty-three publications (22 unique studies) were identified. The unweighted mean wear time was 10.4 days (median ranging from 5 to 14 days). The rate of arrhythmia detection increased with monitoring durations >48 h and continued to increase beyond 7 days of monitoring. Across the 22 studies, unweighted mean detection rates for atrial fibrillation (AF; n ¼ 15), supraventricular tachycardia or supraventricular ectopy (n ¼ 15), and ventricular tachycardia (n ¼ 15) were 12.2%, 45.5% and 17.3%, respectively. Unweighted mean detection rates for chronic/sustained AF (n ¼ 5) and paroxysmal AF (n ¼ 5) were 5.6% and 23.3%, respectively. Conclusion: Findings from the review suggest that long-term, continuous, uninterrupted monitoring with Zio results in longer patient wear times and higher cardiac arrhythmia detection rates compared with outcomes reported in previous reviews of short-duration (24-48 h) cardiac rhythm recording studies. ARTICLE HISTORY

Fast-Track Long Term Continuous Heart Monitoring in a Stroke Clinic: A Feasibility Study

“…The study results showed a high rate (77.1%) of supraventricular tachycardia (SVT) detection among the patient population. Although this rate may seem higher as compared to the pooled data from 22 other studies (60.9%) (32), the results of a comparable study (35) indicate that patients with stroke and TIA may have a higher rate of SVT as compared to patients with no history of cerebral ischemia. A recent study of patients with pacemakers or implantable cardioverter-defibrillators showed subclinical atrial tachyarrhythmia preceding the development of clinical AF (36).…”

Modeling and Estimation of Temporal Episode Patterns in Paroxysmal Atrial Fibrillation

“…None of these measures say anything about whether episodes are clustered or distributed evenly during the monitored period, despite the fact that such information can be relevant for risk assessment of thrombus formation and ischemic stroke, as well as for better understanding arrhythmia progression. Since noninvasive, continuous monitoring has evolved to such a degree that a 14-day period or longer can be covered [35], the prerequisites for episode pattern analysis are becoming increasingly more favorable.…”

Comparison of Continuous ECG Monitoring by Wearable Patch Device and Conventional Telemonitoring Device

“…ZIO® Patch (iRhythm Technologies, Inc., San Francisco, CA, USA), a single-lead patch type device providing continuous ECG monitoring demonstrated higher rates of arrhythmia detection compared to conventional Holter monitor in several studies. 5 18 19 Its water-proof design and small device size without any electric lead or wire enable prolonged ECG monitoring of patients without bothering their daily activities. Another device named SEEQ® MCT (Medtronic, Inc., Minnesota, USA and Ireland, EU) provides wireless data transfer and real-time analysis.…”

“… 4 These new devices have several advantages including light, small and water-proof design, efficient energy use and longer duration of monitoring, wireless data transfer, and no interruption of daily life over conventional Holter recorders. 5 These newer devices can improve quality of life of patients and elongate ECG monitoring duration, diagnostic accuracy and safety should be evaluated.…”