Abstract
BackgroundClinicians rarely scrutinize the full disclosure of a myriad of FDA-approved long-term rhythm monitors, and they rely on manufacturers to detect and report relevant rhythm abnormalities.ObjectiveThe objective of this study is to compare the diagnostic accuracy between mobile cardiac telemetry (MCT), which uses an algorithm-based detection strategy, and continuous long-term electrocardiography (LT-ECG) monitoring, which uses a human-based detection strategy.MethodsIn an outpatient arrhythmia clinic, we enrolled 50 sequential patients ordered to wear a 30-day MCT, to simultaneously wear a continuous LT-ECG monitor. Periods of concomitant wear of both devices were examined using the associated report, which was over-read by 2 electrophysiologists.ResultsForty-six of 50 patients wore both monitors simultaneously for an average of 10.3 ± 4.4 days (range: 1.2–14.8 days). During simultaneous recording, patients were more often diagnosed with arrhythmia by LT-ECG compared to MCT (23/46 vs 11/46), P = .018. Similarly, more arrhythmia episodes were detected during simultaneous recording with the LT-ECG compared to MCT (61 vs 19), P < .001. This trend remained consistent across arrhythmia subtypes, including ventricular tachycardia (13 patients by LT-ECG vs 7 by MCT), atrioventricular (AV) block (3 patients by LT-ECG vs 0 by MCT), and AV node reentrant tachycardia (2 patients by LT-ECG vs 0 by MCT). Atrial fibrillation (AF) was documented by both monitors in 2 patients; however, LT-ECG monitoring captured 4 additional AF episodes missed by MCT.ConclusionIn a time-controlled, paired analysis of 2 disparate rhythm monitors worn simultaneously, human-dependent LT-ECG arrhythmia detection significantly outperformed algorithm-based MCT arrhythmia detection.
Highlights
After a half-century of ambulatory electrocardiogram (ECG) monitoring, physicians rarely have had insight into the large set of hidden variables that affect the quality of the ECG report upon which their medical decisions depend
More arrhythmia episodes were detected during simultaneous recording with the long-term electrocardiography (LT-ECG) compared to mobile cardiac telemetry (MCT) (61 vs 19), P
This trend remained consistent across arrhythmia subtypes, including ventricular tachycardia (13 patients by LT-ECG vs 7 by MCT), atrioventricular (AV) block (3 patients by LT-ECG vs 0 by MCT), and AV node reentrant tachycardia (2 patients by LTECG vs 0 by MCT)
Summary
After a half-century of ambulatory electrocardiogram (ECG) monitoring, physicians rarely have had insight into the large set of hidden variables that affect the quality of the ECG report upon which their medical decisions depend. Those variables extend from circuit board design to electrode design and placement, signal processing, embedded algorithms, analysis software and heuristics, data transmission methods, and, most critically, the presence or absence of human readers of the digitized data either in part or in entirety. Clinicians rarely scrutinize the full disclosure of a myriad of FDA-approved long-term rhythm monitors, and they rely on manufacturers to detect and report relevant rhythm abnormalities
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