Screening for paroxysmal atrial fibrillation in primary care using Holter monitoring and intermittent, ambulatory single-lead electrocardiography

Abstract

Background: Timely detection of atrial fibrillation (AF) is important because of its increased risk of thromboembolic events. Single time point screening interventions fall short in detection of paroxysmal AF, which requires prolonged electrocardiographic monitoring, usually using a Holter. However, traditional 24-48 h Holter monitoring is less appropriate for screening purposes because of its low diagnostic yield. Intermittent, ambulatory screening using a single-lead electrocardiogram (1 L-ECG) device can offer a more efficient alternative.Methods: Primary care patients of ≥65 years participated in an opportunistic screening study for AF. We invited patients with a negative 12 L-ECG to wear a Holter monitor for two weeks and to use a MyDiagnostick 1 L-ECG device thrice daily. We report the yield of paroxysmal AF found by Holter monitoring and calculate the diagnostic accuracy of the 1 L-ECG device's built-in AF detection algorithm with the Holter monitor as reference standard.Results: We included 270 patients, of whom four had AF in a median of 8.0 days of Holter monitoring, a diagnostic yield of 1.5% (95%-CI: 0.4-3.8%). In 205 patients we performed simultaneous 1 L-ECG screening. For diagnosing AF based on the 1 L-ECG device's AF detection algorithm, sensitivity was 66.7% (95%-CI: 9.4-99.2%), specificity 68.8% (95%-CI: 61.9-75.1%), positive predictive value 3.1% (95%-CI: 1.4-6.8%) and negative predictive value 99.3% (95%-CI: 96.6-99.9%).Conclusion: We found a low diagnostic yield of paroxysmal AF using Holter monitoring in elderly primary care patients with a negative 12 L-ECG. The diagnostic accuracy of an intermittently, ambulatory used MyDiagnostick 1 L-ECG device as interpreted by its built-in AF detection algorithm is limited.

14-day Holter monitoring for atrial fibrillation after ischemic stroke: The yield of guideline-recommended monitoring duration

“…The intervention did not achieve higher AF yield than usual care over a 1-year period, mainly underscoring the efficacy of detecting AF in routine primary care in the Netherlands. 11,51 Our work subscribed to previous work which indicated that stroke location among patients with AF on post-stroke monitoring was most often non-lacunar hemispheric, with none or very few AF cases among patients with lacunar stroke/TIA. 6,41 We note here that stroke location in our data was primarily based on clinical symptoms as MRI was not routinely performed in all stroke/TIA patients.…”

“…The intervention did not achieve higher AF yield than usual care over a 1-year period, mainly underscoring the efficacy of detecting AF in routine primary care in the Netherlands. 11 , 51 …”

Wrist-worn device combining PPG and ECG can be reliably used for atrial fibrillation detection in an outpatient setting

“…Karregat et al invited 205 primary care patients aged ≥65 years with a negative 12-lead ECG to wear a Holter monitor for 2 weeks and to use a MyDiagnostick single-lead ECG device three times a day for 60 s ECG recordings. The sensitivity and specificity results of AF detection were 66.7 and 68.8%, respectively, ( 37 ). Svennberg et al used the Zenicor device in an AF screening study on 3,209 persons.…”

The diagnostic efficiency of artificial intelligence based 2 hours Holter monitoring in premature ventricular and supraventricular contractions detection

“…To overcome the limitations of ECG and Holter monitoring, event monitors, implantable loop recorders, and other wearable applications appeared and spread in last decade 13,14 . In particular, the artificial intelligence (AI)‐based single‐lead Holter test exhibits outstanding comfortability and accessibility 15 . Only one patch that adhered to the V2 location on the chest was easy to accept.…”

“… 13 , 14 In particular, the artificial intelligence (AI)‐based single‐lead Holter test exhibits outstanding comfortability and accessibility. 15 Only one patch that adhered to the V2 location on the chest was easy to accept.…”