Newer Diagnostic and Cost-Effective Ways to Identify Asymptomatic Atrial Fibrillation for the Prevention of Stroke

Abstract

Atrial fibrillation (Afib) is the most common and underestimated cardiac arrhythmia with a lifetime risk of >35% after the age of 55 years and the risk continues to rise exponentially. Afib leads to stasis of blood within the atria allowing clot formation and increasing the risk for systemic embolization leading to strokes. Outcomes due to Afib can improve significantly with appropriate treatment. Thus, the need for convenient, well‐tolerated, cost‐effective cardiac monitoring for Afib is needed. The study aims to evaluate the various newer devices and compare them with traditional Holter monitoring, keeping diagnostic yield, cost-effectiveness, and patients' convenience in mind. Though Holter monitoring is simple and non-expensive, it has major limitations including limited recording capacity, inability for real-time recordings, and inconvenience to patients. Zio Patch (iRhythm Technologies, Inc; San Francisco, CA) and other loop recording devices are patient-friendly, inexpensive, and can offer real-time data for longer days. More prospective studies are needed to evaluate the sensitivity, specificity, and the actual number of patients getting benefits from newer devices by diagnosing Afib sooner and start early prevention therapy.

The efficacy of detecting arrhythmia is higher with 7‐day continuous electrocardiographic patch monitoring than with 24‐h Holter monitoring

“…Other types of portable devices include the external loop recorder, which has a recording time of up to 4 weeks, and requires activation by patients during the onset of symptoms. In contrast, patch‐type ECG monitors have no external leads or wires, usually have a recording time of up to 14 days, and continuously monitor the patients' signals; thus, they are more useful in conditions such as syncope 24 . Implantable loop recorders have the longest recording time of up to 3 years, activated by both an automatic algorithm and patient input; however, invasive procedures, high costs, and limited availability constrain their widespread use among patients 24 .…”

“…In contrast, patch‐type ECG monitors have no external leads or wires, usually have a recording time of up to 14 days, and continuously monitor the patients' signals; thus, they are more useful in conditions such as syncope 24 . Implantable loop recorders have the longest recording time of up to 3 years, activated by both an automatic algorithm and patient input; however, invasive procedures, high costs, and limited availability constrain their widespread use among patients 24 . Various devices with different diagnostic yields, cost‐effectiveness, and patient preference and convenience should be considered when choosing diagnostic methods for symptomatic patients or screening high‐risk patients.…”

“…24 Implantable loop recorders have the longest recording time of up to 3 years, activated by both an automatic algorithm and patient input; however, invasive procedures, high costs, and limited availability constrain their widespread use among patients. 24 Various devices with different diagnostic yields, cost-effectiveness, and patient preference and convenience should be considered when choosing diagnostic methods for symptomatic patients or screening high-risk patients.…”

Motion Artifact Reduction in Electrocardiogram Signals Through a Redundant Denoising Independent Component Analysis Method for Wearable Health Care Monitoring Systems: Algorithm Development and Validation

“…Further improvement of noise and MA reduction is critical to achieve an optimal diagnostic yield with wearable health care monitoring systems. The diagnostic yield will be an important determinant of the devices’ cost-effectiveness [ 32 ]. Only with a reliable diagnosis of specific cardiac arrythmias such as atrial fibrillation will the devices’ cost-effectiveness allow widespread application, even in resource-constrained environments [ 33 ].…”