Various arrhythmia types and their day-by-day occurrence rates over a 14-day period using a P-wave sensitive ambulatory ECG monitored population. (3rd October 2022)

• Record Type: Journal Article
• Authors: Bardy, G; Wang, M; Boleyn, R; McLendon, K
• Is Part Of: European heart journal. Volume 43(2022)Supplement 2
• Publication Date: 2022-10-03
• Subjects: Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac544.389
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Many studies on ECG monitoring and arrhythmia detection use the term "diagnostic yield", a vague term and one without the type of diagnostic precision that cardiologists value. Moreover, diagnostic yield of specific arrhythmias is not well understood on a day-by-day basis. Purpose: We used a continuous 14-day ECG monitor to record the incremental occurrence of a broad variety of specific arrhythmias each day from a general outpatient population suspected of having an arrhythmia. Methods: A total of 546 patients were monitored for 14±1 day in the absence of artifact that would otherwise obscure the rhythm. Without such stipulations, arrhythmias could not be truly categorized as a function of time. Patients were randomly selected who satisfied the aforementioned criteria. The studies were prescribed by the patient's managing physician for standard clinical indications, and they spanned across 237 distinct institutions. The recordings were interpreted by 3 serial readers clinically knowledgeable on electrophysiological principles of arrhythmia diagnostics. All reports were then confirmed in their entirety by a cardiac electrophysiologist. The daily diagnostic rate for specific arrhythmia occurrence was then tabulated. Of note, algorithmic and AI diagnostic approaches were not relied upon for arrhythmia diagnoses. Results: Select arrhythmia/conduction abnormalities are shown in the attached Figure, demonstrating different arrhythmias manifesting at different rates. In 61% of pts, at least one rhythm disorder was found that could affect patient management over 14 days. In 28% of pts, two disorders were found while 12% had three or more disorders. P-wave specificity on the ECG aided in identifying 67.9% of those unique arrhythmias. When more than one arrhythmia type was identified, they typically occurred on different days. In contrast, the standard 1-day report, if implemented, would have diagnosed only 20% of patients and rarely would have found multiple rhythm abnormalities Conclusion: Different arrhythmia categories manifest at different rates on a 14-day continuous ECG. Clinical abnormalities in rhythm and/or conduction occur in 61% of patients randomly selected from a broad array of institutions. Moreover, 28% had 2 disorders and 12% had >3 disorders, usually occurring on different days. Lastly, 67.9% of rhythms were identified due to a high fidelity P-wave ECG signal. These findings suggest that a 14-day P-wave sensitive ECG recording has substantive diagnostic value even if a suspected arrhythmia were to occur on day 1. Further, ECG recordings of 1 day (i.e., standard Holter monitor duration) severely diminish diagnostic value and should be avoided. Funding Acknowledgement: Type of funding sources: None.