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Cited by 498ECG Monitoring and AnalysisNon-Invasive Vital Sign MonitoringCardiac pacing and defibrillation studies

Comparison of 24-hour holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring

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Barrett, Paddy M., Komatireddy, Ravi, Haaser, Sharon, Topol, Sarah, Sheard, Judith, Encinas, Jackie, Fought, Angela J., Topol, Eric J.·2014·The American Journal of Medicine
DOI 10.1016/j.amjmed.2013.10.003PMC PMC3882198
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Abstract

BACKGROUND: Cardiac arrhythmias are remarkably common and routinely go undiagnosed because they are often transient and asymptomatic. Effective diagnosis and treatment can substantially reduce the morbidity and mortality associated with cardiac arrhythmias. The Zio Patch (iRhythm Technologies, Inc, San Francisco, Calif) is a novel, single-lead electrocardiographic (ECG), lightweight, Food and Drug Administration-cleared, continuously recording ambulatory adhesive patch monitor suitable for detecting cardiac arrhythmias in patients referred for ambulatory ECG monitoring. METHODS: A total of 146 patients referred for evaluation of cardiac arrhythmia underwent simultaneous ambulatory ECG recording with a conventional 24-hour Holter monitor and a 14-day adhesive patch monitor. The primary outcome of the study was to compare the detection arrhythmia events over total wear time for both devices. Arrhythmia events were defined as detection of any 1 of 6 arrhythmias, including supraventricular tachycardia, atrial fibrillation/flutter, pause greater than 3 seconds, atrioventricular block, ventricular tachycardia, or polymorphic ventricular tachycardia/ventricular fibrillation. McNemar's tests were used to compare the matched pairs of data from the Holter and the adhesive patch monitor. RESULTS: Over the total wear time of both devices, the adhesive patch monitor detected 96 arrhythmia events compared with 61 arrhythmia events by the Holter monitor (P < .001). CONCLUSIONS: Over the total wear time of both devices, the adhesive patch monitor detected more events than the Holter monitor. Prolonged duration monitoring for detection of arrhythmia events using single-lead, less-obtrusive, adhesive-patch monitoring platforms could replace conventional Holter monitoring in patients referred for ambulatory ECG monitoring.

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  • Patch monitors and MCT are the most complete outpatient ECG recording and increase the likelihood for detecting AF, and can provide accurate representation of AF burden for the duration of recording.

    “Patch monitors and MCT are the most complete outpatient ECG recording and increase the likelihood for detecting AF, and can provide accurate representation of AF burden for the duration of recording (Barrett et al., 2014;Rosenberg et al., 2013;Rothman et al., 2007;Turakhia et al., 2013;Schreiber et al., 2014).”

    From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Barrett et al., 2014

    The Results and Discussion report that the continuously recording adhesive patch detected more arrhythmia events than a 24-hour Holter monitor, including additional episodes of atrial fibrillation during extended monitoring. The paper does not establish that patch monitors and MCT are the most complete outpatient ECG options, evaluate MCT, or demonstrate an accurate measure of AF burden over the recording period. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Ambulatory ECG monitoring can establish a diagnosis or make a symptom-rhythm correlation, with longer term monitoring resulting in higher yield.

    “Ambulatory ECG monitoring can be considered to establish a diagnosis or make a symptom-rhythm correlation, with longer term monitoring resulting in higher yield [1,4] .( Table 2 )”

    From Evaluating and managing bradycardia (2020) · cites this paper as [4]

  • Wearable monitors can be as effective or even exceed conventional Holter monitoring to detect arrhythmias owing to their convenient usability over longer periods of time.

    “Although most of these devices are only single lead, they can be as effective or even exceed the ability of conventional Holter monitoring to detect arrhythmias owing to their convenient usability over longer periods of time55,56.”

    From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [55]

  • Several patient-operated devices and extended continuous ECG monitoring using skin patch recorders have been validated for detection of paroxysmal AF.

    “Several patientoperated devices 136,137 and extended continuous ECG monitoring using skin patch recorders 138 have been validated for detection of paroxysmal AF. 139”

    From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [138]

  • Our study examined a more recent time period than prior investigations of long-term continuous monitors and suggests that changes in the device technology and accumulated operator experience may have resulted in improved patient compliance.

    “Our study examined a more recent time period than prior investigations of long-term continuous monitors [5, 9] and suggests that changes in the device technology and accumulated operator experience may have resulted in improved patient compliance.”

    From Incidence and timing of potentially high-risk arrhythmias detected through long term continuous ambulatory electrocardiographic monitoring (2016) · cites this paper as [5]

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Authors
Barrett, P. M., Komatireddy, R., Haaser, S., Topol, S., Sheard, J., Encinas, J., Fought, A. J., & Topol, E. J.
Affiliations
Scripps Health (US)
Corresponding author
Topol, Eric J.
ORCID
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
2014-01
Volume
127
Issue
1
Pages
95.e11-95.e17
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/j.amjmed.2013.10.003
PMC
PMC3882198
OpenAlex
W2079951953
Semantic Scholar
101423c149063dc6c6b0798d5f2e541417d16fbe
Cited by
498
References
20
Citations by year
2026: 35 · 2025: 37 · 2024: 37 · 2023: 33 · 2022: 51 · 2021: 62 · 2020: 38 · 2019: 50 · 2018: 54 · 2017: 50 · 2016: 24 · 2015: 16 · 2014: 9
FWCI
11.09
Type
journal article
Language
en
Open access
Licence
Locations
  • The American Journal of Medicine (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Center for Advancing Translational Sciences (NCT01559246, UL1 TR000109)
  • National Institutes of Health
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords
arrhythmia detection, 24-hour Holter monitoring, Holter monitoring, single-lead ECG, atrial fibrillation, supraventricular tachycardia, ventricular tachycardia, atrioventricular block
MeSH terms
Adhesives, Adult, Aged, Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Electrocardiography, Equipment Design, Female, Humans, Male, Middle Aged, Tachycardia, Supraventricular, Time Factors, Ventricular Fibrillation, Electrocardiography, Ambulatory, Patient Satisfaction, Tachycardia, Ventricular, Atrioventricular Block

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