Atrial fibrillation detection using single lead portable electrocardiographic monitoring: a systematic review and meta-analysis

Abstract

Objectives: Recent technology advances have allowed for heart rhythm monitoring using single-lead ECG monitoring devices, which can be used for early diagnosis of atrial fibrillation (AF). We sought to investigate the AF detection rate using portable ECG devices compared with Holter monitoring.

Setting, participants and outcome measures: We searched the Medline, Embase and Scopus databases (conducted on 8 May 2017) using search terms related to AF screening and included studies with adults aged >18 years using portable ECG devices or Holter monitoring for AF detection. We excluded studies using implantable loop recorders and pacemakers. Using a random-effects model we calculated the overall AF detection rate. Meta-regression analysis was performed to explore potential sources for heterogeneity. Quality of reporting was assessed using the tool developed by Downs and Black.

Results: Portable ECG monitoring was used in 18 studies (n=117 436) and Holter monitoring was used in 36 studies (n=8498). The AF detection rate using portable ECG monitoring was 1.7% (95% CI 1.4 to 2.1), with significant heterogeneity between studies (p<0.001). There was a moderate linear relationship between total monitoring time and AF detection rate (r=0.65, p=0.003), and meta-regression identified total monitoring time (p=0.005) and body mass index (p=0.01) as potential contributors to heterogeneity. The detection rate (4.8%, 95% CI 3.6% to 6.0%) in eight studies (n=10 199), which performed multiple ECG recordings was comparable to that with 24 hours Holter (4.6%, 95% CI 3.5% to 5.7%). Intermittent recordings for 19 min total produced similar AF detection to 24 hours Holter monitoring.

Conclusion: Portable ECG devices may offer an efficient screening option for AF compared with 24 hours Holter monitoring.

Prospero registration number: CRD42017061021.

Figure 1

Overview of inclusion and exclusion of studies based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart.

Figure 2

Forest plot showing the overall atrial fibrillation (AF) detection rate between single-lead ECG devices and Holter monitoring.

Figure 3

Forest plot comparing the atrial fibrillation (AF) detection rate between 24 hours Holter monitoring and performing multiple intermittent single-lead ECG recordings.

Figure 4

Graph showing the linear relationship between total monitoring time and atrial fibrillation (AF) detection rate in single-lead ECG devices.

Figure 5

Cumulative meta-analysis showing minimal variation in atrial fibrillation (AF) detection over time using Holter and single-lead ECG devices.