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. 2022 May 9;24(5):e37970.
doi: 10.2196/37970.

Comparison Between the 24-hour Holter Test and 72-hour Single-Lead Electrocardiogram Monitoring With an Adhesive Patch-Type Device for Atrial Fibrillation Detection: Prospective Cohort Study

Soonil Kwon  1 , So-Ryoung Lee  1 , Eue-Keun Choi  1   2 , Hyo-Jeong Ahn  1 , Hee-Seok Song  3 , Young-Shin Lee  3 , Seil Oh  1   2 , Gregory Y H Lip  1   2   4   5
Affiliations

Comparison Between the 24-hour Holter Test and 72-hour Single-Lead Electrocardiogram Monitoring With an Adhesive Patch-Type Device for Atrial Fibrillation Detection: Prospective Cohort Study

Soonil Kwon et al. J Med Internet Res. .

Abstract

Background: There is insufficient evidence for the use of single-lead electrocardiogram (ECG) monitoring with an adhesive patch-type device (APD) over an extended period compared to that of the 24-hour Holter test for atrial fibrillation (AF) detection.

Objective: In this paper, we aimed to compare AF detection by the 24-hour Holter test and 72-hour single-lead ECG monitoring using an APD among patients with AF.

Methods: This was a prospective, single-center cohort study. A total of 210 patients with AF with clinical indications for the Holter test at cardiology outpatient clinics were enrolled in the study. The study participants were equipped with both the Holter device and APD for the first 24 hours. Subsequently, only the APD continued ECG monitoring for an additional 48 hours. AF detection during the first 24 hours was compared between the two devices. The diagnostic benefits of extended monitoring using the APD were evaluated.

Results: A total of 200 patients (mean age 60 years; n=141, 70.5% male; and n=59, 29.5% female) completed 72-hour ECG monitoring with the APD. During the first 24 hours, both monitoring methods detected AF in the same 40/200 (20%) patients (including 20 patients each with paroxysmal and persistent AF). Compared to the 24-hour Holter test, the APD increased the AF detection rate by 1.5-fold (58/200; 29%) and 1.6-fold (64/200; 32%) with 48- and 72-hour monitoring, respectively. With the APD, the number of newly discovered patients with paroxysmal AF was 20/44 (45.5%), 18/44 (40.9%), and 6/44 (13.6%) at 24-, 48-, and 72-hour monitoring, respectively. Compared with 24-hour Holter monitoring, 72-hour monitoring with the APD increased the detection rate of paroxysmal AF by 2.2-fold (44/20).

Conclusions: Compared to the 24-hour Holter test, AF detection could be improved with 72-hour single-lead ECG monitoring with the APD.

Keywords: ECG; EKG; Holter; arrhythmia; atrial fibrillation; cardiac; cardiac health; cardiology; clinician; diagnosis; diagnostic; digital health; digital tool; electrocardiogram; health monitoring; outpatient clinic; patient; patient monitoring; wearable device.

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Conflict of interest statement

Conflicts of Interest: HSH and YSL: stockholders of Seers Technology Co, Ltd. EKC: research grants or speaking fees from Abbott, Bayer, BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daewoong Pharmaceutical Co, Daiichi-Sankyo, DeepQure, Dreamtech Co, Ltd, Jeil Pharmaceutical Co Ltd, Medtronic, Samjinpharm, Seers Technology, and Skylabs. Stock options from Seers Technology, and Skylabs; GYHL: Consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi-Sankyo. Speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are received personally. SK, SRL, HJA, and SO have none to declare.

Figures

Figure 1
Figure 1
Device setting for electrocardiogram monitoring of a study participant. A study participant recorded a single-lead electrocardiogram (lead II) using an adhesive patch-type device (MC-100) and a three-channel electrocardiogram (lead I, V1, and V6) using the Holter test. Overlap of the electrodes of both devices was avoided to prevent signal noise and interference.
Figure 2
Figure 2
An example of persistent AF (participant #105) detected by the Holter and adhesive patch-type device. Both the Holter and adhesive patch-type device detected AF coherently. AF: atrial fibrillation.
Figure 3
Figure 3
An example of onset and termination of paroxysmal AF detected by the adhesive patch-type device. Both onset and termination of paroxysmal AF can be accurately detected by the adhesive patch-type device. AF: atrial fibrillation.
Figure 4
Figure 4
Comparison of AF detection between the Holter and adhesive patch-type device. The daily proportions of participants with AF were detected by the 24-hour Holter test and 72-hour single-lead electrocardiogram monitoring with the adhesive patch-type device. AF: atrial fibrillation.
Figure 5
Figure 5
Distribution of AF burden measured by the Holter and adhesive patch-type device. The daily AF burdens were compared between 24-hour Holter monitoring and 72-hour single-lead electrocardiogram monitoring with the adhesive patch-type device. AF: atrial fibrillation.
Figure 6
Figure 6
Dynamic changes of daily AF burden. For each participant, daily AF burden was tracked over the monitoring period using the adhesive patch-type device. AF: atrial fibrillation.
Figure 7
Figure 7
An example of short episode of paroxysmal AF detected by the Holter and adhesive patch-type device. Both the Holter and adhesive patch-type device detected a short episode of paroxysmal AF accurately. AF: atrial fibrillation.
Figure 8
Figure 8
Comparison of the detection rates of paroxysmal AF with the adhesive patch-type device (MC-100) by episode durations. Limiting the minimally required duration of AF episodes to 30 seconds decreased the detection rate of paroxysmal AF by 9.1% overall. AF: atrial fibrillation; PAF: paroxysmal atrial fibrillation.
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