Detection of cardiac arrhythmias following acute coronary syndrome using a connected continuous rhythm monitoring device

Abstract

Abstract Background The incidence of cardiac arrhythmias following acute coronary syndrome (ACS) is not well-known. Purpose To describe the incidence of clinically relevant cardiac arrhythmias following low-risk ACS, using a connected continuous rhythm monitoring device. Methods In a prospective, single arm and open label, observational study, patients in sinus rhythm and with a left ventricular ejection fraction > 40% discharged home after an ACS were equipped with a rhythm monitoring tee-shirt, providing a high-quality continuous 15-lead electrocardiogram signals. Patients were prompted to wear the device as much as possible, for a maximum length of 30 days. Recorded data were reviewed by two independent cardiologists. The primary endpoint was the occurrence of clinically relevant arrhythmias – defined as either new atrial fibrillation, ventricular tachycardia, accelerated idioventricular rhythm or frequent premature ventricular contractions (≥ 500/day) – detected by the device over the first 30 days after hospital discharge following the ACS. Results From January 2020 to August 2022, 99 patients were discharged home with a functional rhythm monitoring device, among whom 45 (55%) were ST-segment elevation myocardial infarction. The median recording duration was 13 days (range: 1-30), with a median workable signal of 9 days. Recorded data were interpretable in 82 patients. At least one clinically relevant arrhythmia occurred in 10 patients (12.2%) during follow-up. Median time to first arrhythmia was 16,5 days (IQR: 8,5-23). Paroxysmal atrial fibrillation was detected in 3 patients (3.7%), non-sustained ventricular tachycardia in 4 patients (4.9%), accelerated idioventricular rhythm in 3 patients (3.7%) and frequent premature ventricular contractions in 5 patients (6.1%) (Figure 1). None of these arrhythmias were symptomatic. No sustained ventricular tachycardia was detected. Conclusions Asymptomatic cardiac arrhythmias were frequent after ACS in patients considered at low risk for further events. The long-term clinical risk of these arrhythmias remains to be studied.