Comparison of 24-hour holter monitoring with wire-free, single lead ECG patch monitor in the diagnosis of cardiac rhythm abnormalities

Abstract

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Monitra Healthcare Private Limited Aim There is increasing interest in the development of small, portable ECG patch devices to overcome the cost, patient inconvenience and relatively low diagnostic yield of the ‘gold standard’ Holter monitoring in arrhythmia detection. One such portable device, (study device), is a small, wire-free, adhesive, water-resistant single lead ECG monitoring patch with 24 bit sensor resolution for better p wave capture. The aim of this study was to assess its diagnostic utility compared to standard Holter monitor. Methods A prospective comparison of the study device with the standard Holter monitor (EASI full 12 lead ECG analysis using five electrodes) was done on 37 consecutive patients undergoing 24-hour Holter monitoring. All patients received both the study device and Holter monitor concurrently for 24 hours, and outcomes assessed. Each patient served as a control for themselves. The Holter and study device reports were read by two electrophysiologists blinded to the reports of the other corresponding test. The primary outcome was to compare the detection of arrhythmia and conduction disorders over total wear time for both devices. The matched pairs of data from the two devices were compared using McNemar’s test. Results Over the total wear time of both devices, the study device detected 75 arrhythmias and conduction disturbances compared to 67 by Holter monitor (P=0.02). The diagnostic yield of arrhythmia and conduction disorders by study device and Holter is given in the table. Conclusions The study device ECG patch monitor is comparable to 24-hour Holter monitor. The study device with its 24 bit sensor resolution for better p wave capture resulted in a higher diagnostic yield than the standard 24-hour Holter monitor in the detection of arrhythmias and conduction disorders. Limitation: This is a single centre pilot study on a small sample size. The findings need to be confirmed on a multicenter larger sample size.