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Comparison of 24-hour Holter Monitoring with 14-day Novel Adhesive Patch Electrocardiographic Monitoring
Open accessAbstract
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 (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
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In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“In another study by Barrett PM et al24 it was shown that adhesive patch monitor detected more arrhythmia events compared with the Holter monitor over the total wear time (P < .001), although the Holter monitor detected more events during the initial 24‐h monitoring period (P = .013).”
From Portable out-of-hospital electrocardiography: A review of current technologies (2018) · cites this paper as [24]
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Metadata
- 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.
- 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)
- 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
- hybrid
- doi.org
- 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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