CoChat
Sign Up
Cited by 303ECG Monitoring and AnalysisCardiac pacing and defibrillation studiesCardiac electrophysiology and arrhythmias

2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry

Open access
Steinberg, Jonathan S., Varma, Niraj, Cygankiewicz, Iwona, Aziz, Peter, Balsam, Paweł, Baranchuk, Adrian, Cantillon, Daniel J., Dilaveris, Polychronis +18 more·2017·Heart Rhythm
DOI 10.1016/j.hrthm.2017.03.038
Open this paper in CoChat — free accountOpen PDF

Abstract

Ambulatory ECG (AECG) is very commonly employed in a variety of clinical contexts to detect cardiac arrhythmias and/or arrhythmia patterns which are not readily obtained from the standard ECG. Accurate and timely characterization of arrhythmias is crucial to direct therapies that can have an important impact on diagnosis, prognosis or patient symptom status. The rhythm information derived from the large variety of AECG recording systems can often lead to appropriate and patient-specific medical and interventional management. The details in this document provide background and framework from which to apply AECG techniques in clinical practice, as well as clinical research.

Integrity signals

Registry

Crossref · 10.1016/j.hrthm.2017.03.038

Cites

329 of 329 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

83 of 227 cited sources checked · 29 supported · 5 flagged · accuracy not yet measured

  • Premisecitation

    Sinus tachycardia is identified in nearly 50% of pediatric patients with palpitations.

    “sinus tachycardia is identified in nearly 50% of patients with the same symptoms”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Dick, McFadden, Crowley, & Rosenthal, 1979 source
    • cites Fyfe, Holmes, Neubauer, & Feldt, 1984 source

      The Results report that 21 of 41 patients (51%) had a clinical diagnosis of paroxysmal supraventricular tachycardia before monitoring—not an identification of sinus tachycardia. Among the 21 who transmitted recordings during symptoms, eight had paroxysmal supraventricular tachycardia, one had heart block, and 12 had normal sinus rhythm (Results; Abstract, page unavailable). The paper does not report sinus tachycardia in nearly 50% of patients with palpitations. (LLM, conf=0.87)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites Goldstein, Hesslein, & Dunnigan, 1990

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Premisecitation

    SDNN <50 ms was associated with fivefold higher mortality in postmyocardial infarction patients compared to those with SDNN >50 ms.

    “Kleiger et al. (1987) first reported that SDNN ,50 ms was associated with fivefold higher mortality in postmyocardial infarction patients compared to those with SDNN .50 ms.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Kleiger et al. (1987) source

      Table I (Methods) gives an odds ratio of 5.3 for SDNN below 50 ms relative to the group above 100 ms, not the combined group above 50 ms. The Results likewise describe approximately fourfold higher mortality for the below-50-ms group compared with the above-100-ms group. Thus the claimed fivefold comparison against everyone above 50 ms uses the wrong comparator. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    External AECG serves to detect, document, and characterize abnormal cardiac activity during ordinary daily activities, extending the role of ECG recording beyond the bedside 10-s standard 12-lead resting ECG.

    “External AECG serves to detect, document, and characterize abnormal cardiac activity during ordinary daily activities, extending the role of ECG recording beyond the bedside 10-s standard 12-lead resting ECG (Crawford et al., 1999;Kadish et al., 2001).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Crawford et al., 1999 source
    • cites Kadish et al., 2001 source

      Section IV, “AECG monitoring,” says ambulatory ECG detects, documents, and characterizes abnormal cardiac electrical activity during ordinary daily activities. “C. Background” contrasts AECG recordings with the resting 12-lead ECG and describes their use for transient arrhythmias. Our copy does not specify a bedside, 10-second resting recording, so that detail is not supported by this source. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    More often extended monitoring is necessary because at the time of evaluation the cause of syncope remains elusive due to its transient and intermittent nature.

    “however, more often extended monitoring is necessary as at the time of the evaluation the cause of syncope remains elusive because of its transient and intermittent nature (Baron-Esquivias et al., 2010).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Baron-Esquivias et al., 2010 source

      The “Final diagnosis at the ED” section (page not available) reports that the cause of syncope was unexplained in 28.5% of patients, supporting the point that evaluation can leave its cause undetermined. The paper does not say that extended monitoring is often necessary or attribute the diagnostic difficulty to syncope’s intermittent nature. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Premisecitation

    Up to 7-14 days of ambulatory monitoring with patch ECG monitors yields a high rate of arrhythmia identification.

    “Up to 7-14 days of ambulatory monitoring yields a high rate of arrhythmia identification (Rosenberg et al., 2013;Turakhia et al., 2013).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Rosenberg et al., 2013 source
    • cites Turakhia et al., 2013 source
  • May combine two claims. 100
  • Classified as probably not a substantial claim. 51
  • The quote only partly states this claim. 2

  • May combine two claims.

    Premisecitation

    In NIDCM, the prognostic value of AECG is rather low and remains controversial.

    “in contradistinction to what is reported in patients with ischemic cardiomyopathy, the prognostic value of AECG in NIDCM is rather low and remains controversial”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Goldberger et al., 2007 source

      The Abstract and Discussion report that QT dynamicity measured by 24-hour ECG independently predicts major arrhythmic events in dilated cardiomyopathy and improves risk prediction; the Discussion also identifies nonsustained ventricular tachycardia as an independent predictor. Although the paper calls risk stratification an open issue, its findings run contrary to the blanket claim that ambulatory ECG has rather low prognostic value in this population. Page numbers are unavailable in our copy. (LLM, conf=0.87)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites Goldberger et al., 2014 source

      The Discussion says no individual risk-stratification technique is precise enough for clinical decisions in NIDCM, supporting the claim of limited prognostic value. But Table 2 reports that nonsustained ventricular tachycardia is a significant predictor, while heart-rate variability is not; the paper does not establish that AECG as a whole remains controversial or that its prognostic value is lower than in ischemic cardiomyopathy. The indexed passages provide section labels but no page numbers. (LLM, conf=0.81)

      Experimental — accuracy not yet measured
    • cites Pedersen et al., 2014 source

  • May combine two claims.

    Premisecitation

    Studies have demonstrated the correlation of depressed HRV with risk of mortality including cardiovascular death but not with SCD.

    “Studies have demonstrated the correlation of depressed HRV with risk of mortality including cardiovascular death but not with SCD (Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, 1996;Sassi et al., 2015;Wellens et al., 2014).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, 1996

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Sassi et al., 2015 source

      The paper reports associations with all-cause and cardiovascular mortality, but it contradicts the claim’s exclusion of sudden cardiac death. In “Subjects without evidence of heart disease” (p. 9), it reports that a DFA HRV measure was an independent predictor of sudden cardiac death. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites Wellens et al., 2014 source

      In “Electrical instability and sudden cardiac death” (page unavailable), the paper says that several heart-rate-variability measures predicted SCD in heart-attack survivors with preserved left-ventricular function. It adds that they were stronger predictors of non-SCD, not that they had no association with SCD. The claim’s categorical “but not with SCD” therefore contradicts the cited paper. (LLM, conf=0.87)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Formalized cutoffs for sinus node dysfunction are arbitrary, although a sinus rate <40 bpm is considered potentially causative in a symptomatic patient.

    “It is strongly recommended to establish symptom/ rhythm correlation, as formalized cutoffs are arbitrary although a sinus rate ,40 bpm is considered potentially causative in a symptomatic patient (Epstein et al., 2013).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Epstein et al., 2013 source

      The paper’s study description and results address the difficulty and complications of extracting defibrillator leads with superior vena cava coils; no page numbers are supplied in our copy. Searches for sinus node dysfunction, symptom–rhythm correlation, and a sinus rate below 40 bpm found no passage addressing the cited claim. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There have been major advances in recording and signal processing techniques resulting in enhanced recording fidelity and more sophisticated analysis software.

    “There have been major advances in recording and signal processing techniques resulting in enhanced recording fidelity and more sophisticated analysis software (Kennedy, 2006).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Kennedy, 2006 source

  • May combine two claims.

    Premisecitation

    Both short and longer NSVT episodes (4-7 or ≥8 beats) were significantly associated with 2.3- to 2.8-fold increased annual SCD risk, especially when associated with myocardial ischemia, irrespective of prior MI.

    “both short and longer NSVT episodes (4-7 or 8 beats) were significantly associated with 2.3-to 2.8-fold increased annual SCD risk, especially when associated with the presence of myocardial ischemia irrespective of the presence of prior myocardial infarction”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Scirica et al., 2010 source

      The VT and SCD section reports significant adjusted hazard ratios of 2.3 for 4–7 beats and 2.8 for at least 8 beats over approximately one year; the subgroup analysis reports elevated risk with and without prior MI. Our copy does not show that the association was especially strong in the presence of myocardial ischemia. The Discussion also qualifies the longer-episode finding: episodes within 48 hours of admission were not associated with increased SCD risk. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Following MUSTT, there is a role for AECG for NSVT detection in post-MI patients with LVEF 35%-40% as electrophysiologically guided ICD implantation improves survival.

    “Following the Multicenter Unsustained Tachycardia Trial (MUSTT) (Buxton et al., 1999), there is a role for AECG for NSVT detection in post-MI patients with LVEF 35%-40% as electrophysiologically guided ICD implantation improves survival”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Buxton et al., 1999 source

      The Discussion (page unavailable) reports improved overall survival with defibrillators in patients with coronary disease, nonsustained ventricular tachycardia, LVEF ≤40%, and inducible sustained tachyarrhythmia. The paper supports evaluating such patients for electrophysiologically guided ICD treatment, but the cited passages do not establish a specific role for ambulatory ECG (AECG) screening or a finding specific to the 35%–40% LVEF subgroup. The survival claim also needs the inducible-tachyarrhythmia qualification. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites Epstein et al., 2013 source

      The paper’s opening and conclusion address the difficulty and complications of extracting ICD leads with superior vena cava coils; page numbers are unavailable in our copy. Searches for MUSTT, NSVT detection, post-MI ejection fraction, and electrophysiologically guided ICD implantation found no passage addressing the claim. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites Priori et al., 2015 source

  • Classified as probably not a substantial claim.

    Premisecitation

    In adult patients with CHDs, AECG is considered class IIa for monitoring of arrhythmias and/or conduction disturbances.

    “In adult patients with CHDs, AECG is considered as a class IIa for monitoring of arrhythmias and/or conduction disturbances”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Baumgartner et al., 2010 source

      Section 3.2 (Diagnostic work-up; page unavailable) says that evaluating arrhythmias in grown-up congenital heart disease patients, primarily those with symptoms, may require Holter monitoring or event recorders. The copy does not assign ambulatory ECG monitoring a class IIa recommendation, and the cited passage does not extend monitoring to all adult patients with congenital heart disease. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Khairy et al., 2014 source

  • May combine two claims.

    Premisecitation

    Short-lasting NSVT episodes within the first 48 hr after admission did not carry the same risk, while similar episodes beyond 48 hr were associated with 2.9- to 3.7-fold annual SCD risk.

    “While short-lasting NSVT episodes occurring within the first 48 hr after admission did not carry the same risk, similar episodes that occurred beyond 48 hr were associated with significant (2.9-to 3.7-fold) annual SCD risk.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Scirica et al., 2010 source

      The Timing and Frequency of VT and Risk of SCD section (page unavailable) reports that episodes lasting at least 8 beats were not significantly associated with sudden cardiac death (SCD) when they occurred within 48 hours, but were associated with increased risk when they occurred later. It does not report a 2.9- to 3.7-fold risk specifically for episodes beyond 48 hours. The VT and SCD section gives 2.9% as a one-year SCD rate and 3.7 as the upper confidence limit of a hazard ratio for 4–7-beat episodes, not as the claimed fold-risk range. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Polysomnography is the cornerstone for the diagnosis of sleep apnea and can detect various cardiac arrhythmias (AV block, sinus pauses, NSVT, and paroxysmal AF).

    “The cornerstone for the diagnosis of sleep apnea is polysomnography, during which a variety of cardiac arrhythmias (AV block, sinus pauses, NSVT, and paroxysmal AF) can be detected (Monahan et al., 2009).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Monahan et al., 2009 source

      The Study population and Arrhythmia identification sections (page unavailable) describe using polysomnography to measure sleep-disordered breathing and its ECG channel to identify NSVT and paroxysmal AF. The paper does not establish polysomnography as the cornerstone of sleep-apnea diagnosis or report detecting AV block or sinus pauses. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Paroxysmal supraventricular arrhythmias (including AF) are observed in up to 38% of patients with HCM and are poorly tolerated, contributing to syncopal episodes or heart failure.

    “Paroxysmal supraventricular arrhythmias (including AF) are observed in up to 38% of patients with HCM (Elliott et al., 2014;Gersh et al., 2011) and are poorly tolerated, contributing to syncopal episodes or heart failure.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites Elliott et al., 2014 source
    • cites Gersh et al., 2011 source

      The guideline’s CLASS I discussion says patients with HCM have an increased risk of AF and that AF is poorly tolerated in many, with an increased risk of HCM-related heart failure. It does not give the cited figure of up to 38% for paroxysmal supraventricular arrhythmias, including AF. Its syncope section (6.3.1.1.3; page unavailable) discusses possible arrhythmic syncope but does not specifically link it to those arrhythmias. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    NSVT or PVC burden >1,000/24 hr may predict appropriate ICD discharge, with the latter associated with over threefold higher risk of ICD discharge.

    “NSVT or PVC burden .1,000/24hr may predict appropriate ICD discharge, the latter PVC burden associated with over threefold higher risk of ICD discharge”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Bhonsale et al., 2011 source

  • May combine two claims.

    Premisecitation

    The negative predictive value of NSVT was as high as 90%; however, its positive predictive value was only 20%.

    “The negative predictive value of NSVT was as high as 90%; however, its positive predictive value was only 20%.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Goldberger et al., 2014 source

  • May combine two claims.

    Premisecitation

    NSVT in HCM is characterized by high negative predictive value (95%) but low positive predictive value.

    “Nevertheless, NSVT is characterized by high negative (95%) but low positive predictive values”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Adabag et al., 2005 source

  • May combine two claims.

    Premisecitation

    NSVT was associated with threefold higher risk of arrhythmic events during follow-up, and its prognostic value was enhanced by combination with low LVEF and abnormal QT dynamics.

    “Iacoviello et al. (2007) found that NSVT was associated with threefold higher risk of arrhythmic events during follow-up and that prognostic value of NSVT was enhanced by a combination with low LVEF and abnormal QT dynamics.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Iacoviello et al., 2007 source

      The Clinical correlates of QT dynamicity section reports that NSVT predicted major arrhythmic events and that combining NSVT with low LVEF and a steeper QTe-slope improved risk stratification. The Discussion (p. 230) likewise reports greater predictive value when these measures were combined. The passages do not establish the claimed threefold increase in risk specifically associated with NSVT. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Identification of atrial arrhythmias in ARVD/C is important as it may herald inappropriate ICD therapy, and is associated with higher risk of heart transplantation and cardiac mortality.

    “Identification of atrial arrhythmias is important as it may herald inappropriate ICD therapy, and is associated with a higher risk of heart transplantation and cardiac mortality in patients with ARVD/C”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Saguner et al., 2014 source

  • May combine two claims.

    Premisecitation

    Abnormal HRT seems to be particularly useful in identifying high-risk patients among those with LVEF >30% and is frequently evaluated in risk scores that combine assessment of arrhythmogenic substrate, repolarization instability, and abnormal autonomic nervous system tone.

    “Abnormal HRT seems to be particularly useful in identifying high-risk patients among those with LVEF .30%(Bauer et al., 2008;Cygankiewicz et al., 2009;La Rovere et al., 2012) and is frequently evaluated in risk scores that combine assessment of arrhythmogenic substrate (low LVEF), repolarization instability (e.g., TWA), and abnormal autonomic nervous system tone (HRV).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Bauer et al., 2008 source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites Cygankiewicz et al., 2009 source
    • cites La Rovere et al., 2012 source

  • May combine two claims.

    Premisecitation

    Heart rate turbulence analyzes the baroreceptor-mediated response of the sinus node to premature ventricular beats composed of an early acceleration and subsequent deceleration and is an indicator of baroreceptor sensitivity.

    “Heart rate turbulence analyzes the baroreceptor-mediated response of the sinus node to premature ventricular beats composed of an early acceleration and subsequent deceleration and is an indicator of baroreceptor sensitivity (Schmidt et al., 1999;Bauer et al., 2008).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Schmidt et al., 1999 source
    • cites Bauer et al., 2008 source

  • May combine two claims.

    Premisecitation

    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).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Barrett et al., 2014 source

      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
    • cites Rosenberg et al., 2013 source

      The Results and Discussion (page numbers unavailable) report that the Zio Patch detected more AF episodes than a 24-hour Holter and produced comparable AF-burden estimates. The study did not test mobile cardiac telemetry against the patch or establish that both are the most complete outpatient ECG recording methods, so those broader claims are unsupported by this source. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites Rothman et al., 2007 source

  • May combine two claims.

    Premisecitation

    As symptoms during AF are largely nonspecific or absent, extended AECG recording is helpful to clarify the need for additional treatment, reassure the patient, and predict long-term prognosis.

    “As symptoms during AF are largely nonspecific (or absent), extended AECG recording is helpful to clarify the need for additional treatment (such as pacemaker), to help reassure the patient, and to predict long-term prognosis (Kennedy, 2015).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Kennedy, 2015 source

      The Definitions section says AF can be asymptomatic, and Arrhythmia Detection describes ECG-based methods for detecting silent AF. The paper discusses arrhythmic markers that may predict adverse outcomes, but calls for validated methods and prognostic assessment; it does not establish that extended AECG recording predicts long-term prognosis or say it helps decide on a pacemaker or reassure patients. Page numbers are unavailable in our copy. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    AECG facilitates detection, quantification, and morphology assessment for evaluation of overall PVC burden as a potential cause of tachycardiomyopathy and correlation between symptoms and ECG findings.

    “AECG facilitates detection, quantification, and morphology assessment for the evaluation of the overall PVC burden as a potential cause of”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Baman et al., 2010 source
    • cites Cantillon, 2013 source
    • cites Zipes et al., 2006 source

      Section 5.2.3 (page unavailable) says ambulatory ECG can detect arrhythmias, establish their frequency, and relate symptoms to them. The guidelines also say repetitive monomorphic VT, characterized by frequent ventricular ectopy, can rarely cause tachycardia-related cardiomyopathy (section 7.1.1.4; page unavailable). Our copy does not establish that ambulatory ECG assesses PVC morphology or that overall PVC burden itself is evaluated as a cause of cardiomyopathy. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Current era implantable electronic devices have sophisticated remote monitoring capabilities that are able to evaluate electrical properties of the device itself and also arrhythmias.

    “although current era implantable electronic devices (pacers, ICDs, and CRTs) have sophisticated remote monitoring capabilities that are able to evaluate electrical properties of the device itself and also arrhythmias (Andrikopoulos et al., 2010;Barold, 1998;Dubner et al., 2012;Mittal et al., 2014;Mittal & Steinberg, 2012;Ritter, 2013;Varma & Auricchio, 2013;Varma & Ricci, 2013).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Andrikopoulos et al., 2010 source
    • cites Barold, 1998 source
    • cites Dubner et al., 2012 source

  • May combine two claims.

    Premisecitation

    Very early AF events in the first 2 weeks may predict long-term failure, and AF during the blanking period may indicate greater likelihood of need for additional procedures or drugs.

    “Very early AF events in the first 2 weeks may predict long-term failure (Joshi et al., 2009), and AF during the blanking period may indicate greater likelihood of need for additional procedures or drugs (Arya et al., 2010).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Joshi et al., 2009 source
    • cites Arya et al., 2010 source

      Arya et al. define early recurrence during the first 7 days after ablation and report that it predicts long-term failure (Major findings, p. 5). Their Follow-up section (p. 3) says antiarrhythmic drugs were added after early in-hospital AF recurrence. The paper does not establish that AF throughout the blanking period predicts a greater likelihood of needing additional procedures or drugs; its measured early-recurrence window was narrower, and it does not report that association for repeat procedures. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    A randomized clinical trial involving 572 patients compared 30-day AECG monitoring to 24-to 48-hr Holter recording and found yields of 16.1% vs 3.2% for AF >30s and 9.9% vs 2.5% for AF >2.5 min, with increased anticoagulant prescription.

    “A recent randomized clinical trial involving 572 patients compared 30-day AECG monitoring to 24-to 48-hr Holter recording and found the respective yield to be 16.1% versus 3.2% for AF .30s and 9.9% versus 2.5% for AF .2.5 min, with a resultant increase in prescription of anticoagulant therapy (Gladstone et al., 2014).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Gladstone et al., 2014 source

      The Methods report 572 randomized patients, and Detection of Atrial Fibrillation in the Two Groups gives both detection-rate comparisons. Effect on Treatment reports more anticoagulant use with 30-day monitoring. The comparator, however, was one additional 24-hour Holter recording, not a 24-to-48-hour Holter recording; the Discussion’s reference to standard 24-to-48-hour monitoring describes earlier post-stroke testing. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    A prolonged QT interval predisposes to the development of ventricular tachyarrhythmias such as torsade de pointes and ventricular fibrillation, which could cause syncope, cardiac arrest, or SCD.

    “A prolonged QT interval predisposes to the development of ventricular tachyarrhythmias such as torsade de pointes and ventricular fibrillation, which could cause syncope, cardiac arrest, or SCD (Haverkamp et al., 2000;Moss, 1999;Zareba et al., 1995).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Haverkamp et al., 2000 source
    • cites Moss, 1999 source
    • cites Zareba et al., 1995 source

      The Introduction states that primary QT prolongation is associated with ventricular arrhythmias, syncope and sudden arrhythmic death; the Abstract also includes cardiac arrest among the cardiac events studied. The paper does not identify torsade de pointes or ventricular fibrillation as the specific arrhythmias in this pathway, so that part of the claim is not supported by our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Catheter ablation may increase the proportion of AF events that are asymptomatic, probably by alteration of cardiac neural element.

    “Indeed, catheter ablation may increase the proportion of AF events that are asymptomatic, probably by alteration of cardiac neural element (Hindricks et al., 2005).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hindricks et al., 2005 source

      The Main Findings section reports that asymptomatic AF increased after ablation. The Perception of AF After Catheter Ablation section suggests that effects on the heart’s autonomic nervous system may affect AF perception, but says the mechanism is not completely understood and needs further study. The claim’s “probably by alteration” states that explanation more confidently than the source does. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Postdischarge AECG recording after cryptogenic stroke has particular utility, although AF detection is sensitive to patient selection, definition of AF, and duration of monitoring.

    “Postdischarge AECG recording after cryptogenic stroke has particular utility (Marini et al., 2005) although AF detection is sensitive to the patient selection process, the definition of AF, and the duration of monitoring.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Marini et al., 2005 source

      The Subjects and Methods (p. 2) describe standard 12-lead ECG assessment at stroke onset and during the acute phase, not postdischarge ambulatory ECG recording after cryptogenic stroke. A 7-day ambulatory ECG study appears in the References (p. 5), but this paper does not report or discuss the claimed particular utility. Searched for postdischarge monitoring and cryptogenic stroke. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The feasibility of continuous human monitoring of multiple screens is questionable and costly, pulling nurses away from direct patient care and education.

    “However, the feasibility of continuous human monitoring of multiple screens is questionable and costly, pulling nurses away from direct patient care and education (Drew et al., 2004).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Drew et al., 2004 source

      In “Use of Dedicated Monitor Watchers” (page not provided), the paper says watching multiple screens is difficult, dedicated watchers are costly, and staff nurses cannot continually watch monitors while providing direct patient care. It does not say monitoring pulls nurses away from patient education; its discussion of education concerns training nurses to use monitoring equipment. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The AP location was confirmed to be located right posteroseptally during intracardiac recordings.

    “The AP location was confirmed to be located right posteroseptally during intracardiac recordings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The P waves in the tachycardia shown in Figure 1A have a short RP interval and are negative in the inferior leads.

    “The P waves have a short RP interval and are negative in the inferior leads”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    During the first attempt at RF catheter ablation, the tachycardia showed a slowing in rate (165 bpm) with a marked increase in RP interval (Figure 1B).

    “During the first attempt at RF catheter ablation, the tachycardia showed a slowing in rate (165 bpm) with a marked increase in RP interval (Figure 1B).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Findingreasoning

    Continuing ablation of the slower pathway terminates the AFL.

    “Continuing ablation of the slower pathway terminates the AFL.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The narrow QRS tachycardia shown in Figure 1B is a long RP tachycardia with negative P waves in the inferior ECG leads.

    “The narrow QRS tachycardia shown in Figure 1B is a long RP tachycardia with negative P waves in the inferior ECG leads.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    The narrow QRS tachycardia shown in Figure 1A has a rate of 210 bpm and shows a 1:1 relationship between QRS and P wave.

    “The narrow QRS tachycardia shown in Figure 1A has a rate of 210 bpm and shows a 1:1 relationship between QRS and P wave.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The writing committee's final recommendations were reviewed by all members, and each member voted for inclusion with an 80% vote threshold.

    “The final recommendations were reviewed by all writing committee members, and each member voted for inclusion with the vote threshold set at 80%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisereasoning

    Generally, the higher the number of leads, the higher the complex detection precision.

    “Generally speaking, the higher the number of the leads the higher the complex detection precision.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Supraventricular tachycardias are a rare cause of syncope, with exceptions in the setting of heart failure or cardiomyopathy, or during postconversion sinus pause.

    “Supraventricular tachycardias are a rare cause of syncope, with exceptions in the setting of heart failure or cardiomyopathy, or during postconversion sinus pause.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Errors of omission include failure to properly address patients with potentially serious arrhythmic events.

    “Errors of omission include failure to properly address patients with potentially serious arrhythmic events.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    In some patients, supraventricular tachyarrhythmias produce QRS aberration and present as a wide complex tachycardia.

    “In some patients, supraventricular tachyarrhythmias produce QRS aberration and present as a wide complex tachycardia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Errors of commission include recommending the wrong medication or potentially harmful and unnecessary interventional procedures such as cardiac catheterization, electrophysiological study, or implantation of arrhythmia devices.

    “Errors of commission include, but are not confined to, recommending the wrong medication or potentially harmful and unnecessary interventional procedures such as cardiac catheterization, electrophysiological study, or implantation of arrhythmia devices (Krasnow & Bloomfield, 1976).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Krasnow & Bloomfield, 1976 source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Supraventricular tachycardias are diagnosed by the presence of a narrow complex rhythm with QRS complex similar to that of sinus rhythm in most cases.

    “They are diagnosed by the presence of a narrow complex rhythm with QRS complex similar to that of sinus rhythm in most cases.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Adhesive ECG patch devices with embedded electrodes and sensor shirts featuring textile electrodes are better accepted by patients and improve compliance with extended monitoring.

    “Adhesive ECG patch devices with embedded electrodes and sensor shirts featuring textile electrodes (sometimes called “textrodes”) are better accepted by the patients and improve compliance with extended monitoring”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Lobodzinski, 2013 source
    • cites Lobodzinski & Laks, 2008, 2012

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Perez de Isla et al., 2011 source

  • May combine two claims.

    Premisecitation

    Ambulatory ECGs recorded with torso placement of the extremity electrodes cannot be considered equivalent to standard ECGs for all purposes and should not be used interchangeably with standard ECGs for serial comparison.

    “Ambulatory ECGs recorded with torso placement of the extremity electrodes cannot be considered equivalent to standard ECGs for all purposes and should not be used interchangeably with standard ECGs for serial comparison (Papouchado, Walker, James, & Clarke, 1987).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Papouchado, Walker, James, & Clarke, 1987 source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    The accuracy of waveform classification highly depends on the redundancy of the information contained in a multilead system.

    “The accuracy of the waveform classification highly depends on the redundancy of the information contained in a multilead system.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    A variety of AECG recorders can indicate whether sinus node competency is inadequate to match the metabolic demands of the individual patient and produce symptoms.

    “A variety of AECG recorders can indicate whether sinus node competency is inadequate to match the metabolic demands of the individual patient and produce symptoms.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    A 12-lead ECG is the diagnostic test of choice for long QT syndrome, rather than an AECG.

    “For example, a 12-lead ECG is the diagnostic test of choice for long QT syndrome (LQTS), rather than an AECG.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Some AECG devices feature multiple biological signal sensors that allow simultaneous recording of multilead ECGs along with respiratory rate, peripheral oxygen saturation, physical activity, skin temperature, arterial pulse pressure, and other parameters, providing comprehensive evaluation of patients with complex disorders such as heart failure or sleep apnea syndromes.

    “Some AECG devices also feature multiple biological signal sensors that allow for simultaneous recording of multilead ECGs along with respiratory rate, peripheral oxygen saturation, physical activity, skin temperature, arterial pulse pressure, and other parameters”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Locati, 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Developers of ECG processing algorithms usually use the annotated MIT-BIH ECG and arrhythmia databases available on physionet.org to tune their algorithms.

    “The developers usually use the annotated MIT-BIH ECG and arrhythmia databases available on physionet.orgto tune their algorithms (George & Roger, 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites George & Roger, 2001

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    The role of the AECG in syncope is to identify bradyarrhythmias (e.g., sinus pauses, periods of AV block) or tachyarrhythmias (e.g., sustained VT).

    “The role of the AECG is to identify (Watanabe et al., 2014) bradyarrhythmias (e.g., sinus pauses, periods Heart Rhythm, Vol 14, No 7, July 2017 of atrioventricular [AV] block), or tachyarrhythmias (e.g., sustained VT).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Watanabe et al., 2014 source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    AECG monitoring is only one component of the investigation for ventricular tachyarrhythmias and is most useful if recorded during symptoms.

    “AECG monitoring is only one component of the investigation and most useful if recorded during symptoms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Palpitations are the most frequent indication for AECG and one of the main reasons why AECG was originally developed.

    “Palpitations are the most frequent indication for AECG, and one of the main reasons why AECG was originally developed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    In general, the diagnostic yield of AECG for syncope is limited and dependent on the frequency of clinical symptoms.

    “The type of recorder and the duration of recording should be tailored to the individual patient's history, but in general, the diagnostic yield is limited and dependent on the frequency of clinical symptoms.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    There may be value in using AECG recording for exercise-induced arrhythmias, especially for adolescents, to facilitate recordings during more natural activities and stimulate levels of exertion not achieved in an artificial environment, enhancing symptom-rhythm correlation.

    “Although exercise-induced arrhythmias are typically worked up via an exercise treadmill examination, there may be value in using AECG recording, especially for adolescents.This may facilitate recordings during more natural activities and also stimulate levels of exertion not achieved in an artificial environment, enhancing symptom-rhythm correlation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Up to 20% of outpatients present with palpitations and most cases have benign causes.

    “Up to 20% of outpatients present with palpitations and most of the cases have benign causes (Kroenke, Arrington, & Mangelsdorff, 1990).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kroenke, Arrington, & Mangelsdorff, 1990

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    The Danish health system has formally implemented a prehospital ECG system for several years, processing about 4,000 ECGs per year.

    “The Danish health system has formally implemented such a system for several years, processing about 4,000 ECGs per year”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Clemmensen et al., 2013 source

  • May combine two claims.

    Premisecitation

    In another study, the median time for recording a symptom-rhythm correlation was 16 days for patients assigned a loop recorder as their first diagnostic strategy, and symptom-rhythm correlation was obtained in 87% of patients by 1 month of monitoring.

    “In another study, the median time for recording a symptom-rhythm correlation was 16 days for patients assigned a loop recorder as their first diagnostic strategy and symptom-rhythm correlation was obtained in 87% of patients by 1 month of monitoring (Bass et al., 1990).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bass et al., 1990 source

  • May combine two claims.

    Interpretationreasoning

    Prehospital diagnosis has practical advantages: directing emergency transport to the optimal facility, bypassing the emergency department, and preparation at the receiving facility for emergent PCI and associated treatment.

    “prehospital diagnosis has specific practical advantages: directing emergency transport to the optimal facility, bypassing the emergency department, and preparation at the receiving facility for emergent PCI and associated treatment”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Early reperfusion via percutaneous coronary intervention is the critical therapeutic intervention for patients with ST elevation myocardial infarction.

  • May combine two claims.

    Premisecitation

    AECG monitoring can be utilized to diagnose the etiology of chest pain (both atherosclerotic coronary artery disease and Prinzmetal's variant angina), identify episodes of atypical chest pain without apparent surface ECG manifestation, and assess the magnitude of ischemic burden.

    “Ambulatory ECG monitoring can be utilized to diagnose the etiology of chest pain (both atherosclerotic coronary artery disease and Prinzmetal's variant angina), identify episodes of atypical chest pain that do not have an apparent manifestation on the surface ECG, and assess the magnitude of “ischemic burden,” the product of duration of ischemia and the magnitude of ST-segment depression.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Although a detailed history, physical examination, and 12-lead ECG are sufficient to make a definitive diagnosis in up to one-third of patients with palpitations, in the remainder AECG is the most cost-effective clinical tool.

    “Although a detailed history, physical examination, and 12-lead ECG are sufficient to make a definitive diagnosis in up to one-third of patients with palpitations, in the remainder AECG is the most costeffective clinical tool (Weber & Kapoor, 1996).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Weber & Kapoor, 1996 source

  • May combine two claims.

    Premisecitation

    The majority of episodes of ambulatory ischemia in patients with coronary disease are asymptomatic, and therefore objective ECG monitoring such as AECG can be used to identify the severity of ischemia during daily activities.

    “The majority of episodes of ambulatory ischemia in patients with coronary disease are asymptomatic, and therefore objective ECG monitoring, such as with the AECG, can be used to identify the severity of ischemia during daily activities (Birnbaum et al., 2014).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Birnbaum et al., 2014 source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Many patients with depressed left ventricular function will be candidates for implantable cardioverter defibrillator based on left ventricular ejection fraction, and others may require electrophysiological study for programmed stimulation to elicit VT.

    “Many patients with depressed left ventricular function will be candidates for implantable cardioverter defibrillator (ICD) based on left ventricular ejection fraction (LVEF), and others may require electrophysiological study for programmed stimulation to elicit VT.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The Danish rapid triage system confirms technical feasibility and suggests measurable clinical impact.

    “confirming technical feasibility and suggesting measurable clinical impact”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Typically, diagnosed rhythms reflect prevalence of arrhythmias in the studied populations.

    “Typically, diagnosed rhythms reflect prevalence of arrhythmias in the studied populations (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The relevance of identified spontaneous arrhythmias to palpitations is variable and could be low.

    “The relevance of identified spontaneous arrhythmias to the palpitations is variable and could be low (Lok & Lau, 1996;Zeldis, Levine, Michelson, & Morganroth, 1980).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Lok & Lau, 1996 source
    • cites Zeldis, Levine, Michelson, & Morganroth, 1980 source

  • May combine two claims.

    Premisecitation

    Continuous-loop recorders provided higher diagnostic yield compared to 24-hr Holter and have proved to be more cost-effective.

    “Continuousloop recorders provided higher diagnostic yield, as compared to 24-hr Holter, and have proved to be more cost-effective (Fogel, Evans, & Prystowsky, 1997).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Fogel, Evans, & Prystowsky, 1997 source

  • May combine two claims.

    Premisecitation

    In one study of short-term Holter monitoring, symptoms correlated with a documented arrhythmia in 4% and occurred without an arrhythmia on the monitor in 17%.

    “When pursuing the second objective, one study of short-term Holter monitoring found that symptoms correlated with a documented arrhythmia in 4% and occurred without an arrhythmia on the monitor in 17% (Morillo & Baranchuk, 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Morillo & Baranchuk, 2004 source

  • May combine two claims.

    Premisenone given

    Loop event recorders and interactive ECG applications that save and transmit ECG only when the patient activates the monitor provide better correlation with symptoms but require that the patient be vigilant and capable of activating the recording in time.

    “Such devices provide better correlation with symptoms, but require that the patient be vigilant and capable of activating the recording in time.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    The diagnostic yield of AECG directly correlates with the duration of AECG monitoring and depends on the percentage of accurate reporters in the studied population.

    “The diagnostic yield of AECG directly correlates with the duration of AECG monitoring and depends on the percentage of “accurate reporters” in the studied population.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    AECG has low diagnostic yield for chest pain in pediatric patients but has utility to exclude cardiac- or rhythm-related etiologies as a means of providing reassurance.

    “Therefore, AECG has low diagnostic yield but has utility to exclude cardiac-or rhythm-related etiologies to symptoms as a means of providing reassurance to patients and families.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    NSVT detection among MI survivors yielded low prognostic value for subsequent mortality and no prognostic value when only arrhythmic events were considered.

    “NSVT detection among MI survivors yielded low prognostic value for subsequent mortality and no prognostic value when only arrhythmic events were considered”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hohnloser et al., 1999 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In asymptomatic patients with Wolff-Parkinson-White, recent guidelines favor exercise stress testing to detect beat-to-beat loss of preexcitation.

    “In asymptomatic patients with Wolff-Parkinson-White, recent guidelines favor exercise stress testing to detect beat-to-beat loss of preexcitation”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pediatric and Congenital Electrophysiology Society [PACES] et al., 2012

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    AECG can accomplish detection of beat-to-beat loss of preexcitation, though lead analysis and electrogram quality are typically inferior to 12-lead rhythm strip during formal stress testing.

    “This may be accomplished with AECG though typically lead analysis and electrogram quality are inferior to those obtained during 12-lead rhythm strip evaluation during formal stress testing.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    AECG is a class I recommendation for patients with repaired CHDs or significant residual hemodynamic abnormalities.

    “AECG is a class I recommendation for patients with repaired CHDs or for patients with significant residual, hemodynamic abnormalities”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Crawford et al., 1999 source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The failure to link an effective therapeutic intervention following AECG findings has probably limited its utilization in clinical practice.

    “The failure to link an effective therapeutic intervention following these AECG findings has probably limited its utilization in clinical practice.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Patients may have multiple rhythm disturbances and recording an asymptomatic rhythm disturbance does not necessarily imply high risk.

    “On the other hand, patients may have multiple rhythm disturbances and recording an asymptomatic rhythm disturbance does not necessarily imply high risk.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    24-hr AECG was sufficient to document the required Task Force criterion of over 500 PVCs in nearly 90% of ARVD/C cases, and extension to 96 hr increased correct classification to 95.5%.

    “Camm et al. (2015) reported that 24-hr AECG was sufficient to document the required Task Force criterion of over 500 PVCs in nearly 90% of cases, and extension of monitoring to 96 hr increased the number of correct classification to 95.5%.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Camm et al., 2015 source

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    For many competitive athletes, the sport itself is required to initiate the symptom and potentially the arrhythmia.

    “However, for many competitive athletes, the sport itself is required to initiate the symptom and potentially the arrhythmia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The type of monitoring depends on symptom frequency, severity, duration, and type of circumstances surrounding the symptoms.

    “The type of monitoring depends on symptom frequency, severity, duration, and type of circumstances surrounding the symptoms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the Marburg Cardiomyopathy study, NSVT evaluated alone was not associated with increased risk of arrhythmic events; however, when combined with low LVEF, the risk was eightfold higher.

    “In Marburg Cardiomyopathy study (Grimm, Christ, Bach, M€ uller, & Maisch, 2003), NSVT evaluated alone was not associated with an increased risk of arrhythmic events; however, when combined with low LVEF, the risk was eightfold higher.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Grimm, Christ, Bach, M€ uller, & Maisch, 2003 source

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The detection of any NSVT in patients with borderline EF (35%-40%) might prompt further risk stratification and determination of need for ICD using EPS.

    “The detection of any NSVT in patients with borderline EF (e.g., 35%-40%) might prompt further risk stratification and determination of need for ICD using EPS.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Rhythm disturbances by themselves do not necessarily elicit symptoms, and some rhythm disturbances can occur with or without symptoms.

    “Rhythm disturbances, by themselves, do not necessarily elicit symptoms, and some rhythm disturbances can occur with or without symptoms.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Because polysomnography is not universally available and can be logistically cumbersome, screening larger at-risk populations would be advantaged by simpler and less expensive diagnostic tests.

    “Because polysomnography is not universally available and can be logistically cumbersome, screening larger populations at risk would be advantaged by simpler and less expensive diagnostic tests.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Heart rate variability detects autonomic nervous system tone based on beat-to-beat RR intervals.

    “It detects autonomic nervous system tone based on beat-to-beat RR intervals.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Overall, the data regarding NSVT in NIDCM are weak and do not support routine use of noninvasive techniques in this population.

    “Overall, the data regarding NSVT are weak and do not support routine use of noninvasive techniques in this population.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Multiple studies have consistently confirmed the prognostic value of HRV in predicting overall mortality and heart failure progression.

    “Multiple studies have consistently confirmed the prognostic value of HRV in predicting overall mortality and heart failure progression (La Rovere et al., 2003Rovere et al., , 2012)).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites La Rovere et al., 2003 source
    • cites La Rovere et al., 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Nonlinear HRV analysis is believed to be less dependent on preprocessing and to express better the complexity of RR changes.

    “Nonlinear HRV analysis is believed to be less dependent on preprocessing and to express better the complexity of RR changes (Perkiomaki et al., 2000).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Perkiomaki et al., 2000 source

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The type of monitoring depends on the type of athletic participation and the arrhythmia and symptom being assessed.

    “In addition, the type of monitoring depends on the type of athletic participation and the arrhythmia and symptom being assessed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    For athletes, symptoms suspicious of an arrhythmia can rarely be a premonitory sign of SCD and may indicate an otherwise potentially serious but treatable condition or arrhythmia.

    “For the athlete, symptoms suspicious of an arrhythmia, rarely, can be a premonitory sign of SCD and may indicate an otherwise potentially serious but treatable condition or arrhythmia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Both the MUSIC and GISSI-HF trials documented that abnormal TS predicts not only total mortality but also SCD and/or appropriate ICD discharge in ambulatory patients with mild-to-moderate heart failure.

    “Moreover, both the MUSIC and GISSI-HF trials, which enrolled ambulatory patients with mild-tomoderate heart failure, documented that abnormal TS predicts not only total mortality but also SCD and/or appropriate ICD discharge (Cygankiewicz et al., 2008;La Rovere et al., 2012).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Cygankiewicz et al., 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites La Rovere et al., 2012 source

  • May combine two claims.

    Premisecitation

    The FINGER study documented that only abnormal turbulence slope (TS) and NSVT were significantly associated with an increased risk of SCD; patients with abnormal slope had almost threefold higher risk than those with normal slope.

    “The FINGER (FINland and GERmany Postinfarction) study documented that only abnormal turbulence slope (TS) and NSVT were significantly associated with an increased risk of SCD; patients with abnormal slope had almost threefold higher risk than those with normal slope (Makikallio et al., 2005).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Makikallio et al., 2005 source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Technical difficulties in QTV assessment include identification of the end of the T wave, differences among leads, and effects of T-wave amplitude.

    “Technical difficulties in QTV assessment include identification of the end of the T wave, differences among leads, and effects of T-wave amplitude.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Study design and conductnone given

    Only Holter recordings with at least 5 PVCs are considered reliable for HRT calculation.

    “Only Holter recordings with 5 PVCs are considered reliable for HRT calculation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Normative QTV values have not been established, there are no agreed cutpoints indicating elevated risk, and QTV studies do not provide evidence of its capacity to guide therapy.

    “Important limitations include the facts that (1) normative QTV values have not been established; (2) there are no agreed cutpoints indicating elevated risk; and (3) QTV studies do not provide evidence of its capacity to guide therapy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The REFINE study showed that patients with both abnormal HRT and TWA had a fourfold higher risk of arrhythmic events, while the MUSIC study documented that a combination of abnormal TS, decreased SDNN, and increased repolarization dynamicity (QT/RR) was associated with the highest risk of sudden death in patients with heart failure and LVEF >35%.

    “The REFINE study showed that patients with both abnormal HRT and TWA had a fourfold higher risk of arrhythmic events, while the MUSIC study documented that a combination of abnormal TS, decreased SDNN, and increased repolarization dynamicity (QT/RR) was associated with the highest risk of sudden death in patients with heart failure and LVEF .35%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    QT-RR dynamicity can be altered in patients with ischemic heart disease, congenital and acquired LQTSs, where the QT-RR pattern differs according to genotypes, and the Brugada syndrome.

    “QT-RR dynamicity can be altered in patients with ischemic heart disease, congenital, and acquired LQTSs, where the QT-RR pattern differs according to genotypes, and the Brugada syndrome (Chevalier et al., 2002s;Cygankiewicz et al., 2008;Fujiki et al., 2004;Jensen et al., 2005).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Chevalier et al., 2002s source
    • cites Cygankiewicz et al., 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Fujiki et al., 2004 source

  • May combine two claims.

    Premisecitation

    The GISSI Holter substudy showed that SDNN, VLF, LF, and detrended fluctuation analysis were independent risk predictors for cardiovascular death, while VLF and LF were associated with sudden death or appropriate ICD discharge.

    “The GISSI Holter substudy in a contemporary population of heart failure patients showed that SDNN, VLF, LF, and detrended fluctuation analysis were independent risk predictors for cardiovascular death, while VLF and LF were associated with sudden death or appropriate ICD discharge (La Rovere et al., 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites La Rovere et al., 2012 source

  • May combine two claims.

    Premisecitation

    Increased QTV index is associated with both all-cause mortality and cardiovascular mortality in patients with acute myocardial infarction or heart failure and in resuscitated cardiac arrest.

    “Increased QTV index is associated with both all-cause mortality and cardiovascular mortality in patients with acute myocardial infarction or heart failure and in resuscitated cardiac arrest (Dobson et al., 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Dobson et al., 2013 source

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The absence of randomized clinical trials to assess the capacity of these parameters to guide therapeutic interventions to prevent SCD is a major deficiency.

    “The absence of randomized clinical trials to assess the capacity of these parameters to guide therapeutic interventions to prevent SCD is a major deficiency.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Three-channel AECGs are suitable for detection and quantification of ventricular arrhythmia burden, whereas 12-channel recorders more reliably diagnose PVC origin and reveal aberrant supraventricular conduction as a cause for wide complexes.

    “Three-channel AECGs are suitable for detection and quantification of ventricular arrhythmia burden.However, 12-channel recorders more reliably diagnose PVC origin (and reveal aberrant supraventricular conduction as a cause for wide complexes), useful for decisions regarding catheter ablation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Treatment of ventricular arrhythmias is sometimes utilized for relief of symptoms and/or suppression of frequent PVCs that cause left ventricular dysfunction.

    “Treatment of ventricular arrhythmias is sometimes utilized for relief of symptoms and/or suppression of frequent PVCs that cause left ventricular dysfunction (Pedersen et al., 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pedersen et al., 2014 source

  • May combine two claims.

    Premisecitation

    Some patients exhibit very-high-density atrial ectopy that can serve as AF triggers, and 24-hr recordings that contain >1,000 atrial premature beats may be candidates for ablation of these focal triggers.

    “Some patients exhibit very-high-density atrial ectopy that can serve as AF triggers as well, and 24-hr recordings that contain .1,000atrial premature beats may be candidates for ablation of these”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Calkins et al., 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    The definition of AF has been set as a minimum of 30 s, but this is not based on any data analysis of AF duration and patient outcome.

    “The definition of AF has been set as a minimum of 30 s (Calkins et al., 2012), but this is not based on any data analysis of AF duration and patient outcome.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Calkins et al., 2012 source

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Most antiarrhythmic drugs also exert negative chronotropic and dromotropic effects.

    “Most antiarrhythmic drugs also exert negative chronotropic and dromotropic effects.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Sudden death occurs largely in subjects in whom left ventricular ejection fraction has proven insufficient for risk stratification.

    “since sudden death occurs largely in subjects in whom left ventricular ejection fraction has proven insufficient for risk stratification.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Class 1C drugs can transform AF into atrial flutter with 1:1 AV conduction or aggravate preexisting conduction abnormalities causing QRS prolongation or patterns of AV block.

    “Class 1C drugs (e.g., flecainide, propafenone) can transform AF into atrial flutter with 1:1 AV conduction or aggravate preexisting conduction abnormalities causing QRS prolongation or patterns of AV block.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Class III antiarrhythmic drugs risk torsade de pointes, which may be presaged by increasing QT intervals, prominent U waves, TWA, and greater prevalence of ventricular ectopy.

    “Class III antiarrhythmic drugs risk torsade de pointes, which may be presaged by increasing QT intervals (particularly postpause), prominent U waves, TWA, and greater prevalence of ventricular ectopy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    AECG monitoring plays an essential role in establishing indications for pacemaker implantation.

    “AECG monitoring plays an essential role in establishing indications for pacemaker implantation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The minimal duration of AECG monitoring is uncertain, and 30-day recordings have identified as high as a 20% prevalence of AF.

    “The minimal duration of AECG monitoring is uncertain, and 30-day recordings have identified as high as a 20% prevalence of AF (Kishore et al., 2014).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kishore et al., 2014 source

  • May combine two claims.

    Premisecitation

    Fewer leads simplify connections and nursing workflow and add less bulk, but attenuate ability for myocardial ischemia detection with continuous ST-segment monitoring.

    “Fewer leads simplify connections and nursing workflow, and add less bulk, but attenuate ability for myocardial ischemia detection with continuous STsegment monitoring (Drew & Krucoff, 1999).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Drew & Krucoff, 1999 source

  • May combine two claims.

    Premisecitation

    Serious adverse events including death have resulted from alarm fatigue, and these are likely heavily under-reported.

    “Conversely, serious adverse events including death have resulted from alarm fatigue, and these are likely heavily under-reported (Pennsylvania Patient Safety Authority, 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pennsylvania Patient Safety Authority, 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    For elite athletic screening, single-lead AECG recordings have been shown to be equivalent to 12-lead ECG screening for detection of rate and rhythm disturbances and for assessment of conduction intervals.

    “For elite athletic screening, such single-lead AECG recordings have been shown to be equivalent to 12lead ECG screening for detection of rate and rhythm disturbances and for assessment of conduction intervals (Haberman et al. 2015;Lowres et al., 2014;Nguyen et al., 2015;Tarakji et al., 2015).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Haberman et al. 2015;Lowres et al., 2014;Nguyen et al., 2015

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Home-based telemonitored cardiac rehabilitation is feasible and safe in patients suffering from heart failure.

    “Home-based telemonitored cardiac rehabilitation is also feasible and safe in patients suffering from heart failure (Kouidi et al., 2006;Piotrowicz et al., 2010;Smart et al., 2005).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kouidi et al., 2006;Piotrowicz et al., 2010;Smart et al., 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    A Cochrane Collaboration review and meta-analysis reported that telemedicine (structured telephone support or telemonitoring) significantly reduced heart failure-related hospitalizations, but these results were not confirmed by two subsequent large randomized controlled trials.

    “While a Cochrane Collaboration review and meta-analysis reported that telemedicine (structured telephone support or telemonitoring) significantly reduced heart failure-related hospitalizations (Inglis et al., 2011), these results were not confirmed by two subsequent large randomized controlled trials (Chaudhry et al., 2010;Koehler et al., 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Inglis et al., 2011;Chaudhry et al., 2010;Koehler et al., 2011

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Incorrect electrode placement was found in 26% in one study, but improved with educational interventions, with immediate direct impact on signal quality of monitoring (reducing noise artifact).

    “Incorrect electrode placement was found in 26% in one study, but improved with educational interventions (Pettersen et al., 2014) with immediate direct impact on signal quality of monitoring (reducing noise artifact).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pettersen et al., 2014 source

  • May combine two claims.

    Premisecitation

    Following an 8-week training program, significant improvements were observed in NYHA class, peak oxygen consumption, 6-minute walking test distance, and quality of life scores.

    “Following an 8-week training program, significant improvements were observed in NYHA class, peak oxygen consumption, 6-minute walking test distance, and quality of life scores.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kouidi et al., 2006;Piotrowicz et al., 2010;Smart et al., 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    The remote monitoring system for WCD can chart compliance (wear time on a daily basis), patient activity, and orthopnea, potentially important for heart failure management.

    “Apart from continuous arrhythmia monitoring, the remote monitoring system can chart compliance (wear time on a daily basis), patient activity, and orthopnea, potentially important for heart failure management (Kutyifa et al., 2015).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kutyifa et al., 2015 source

  • May combine two claims.

    Premisecitation

    Home-based cardiac rehabilitation programs using ECG transtelephonic monitoring were found to be efficacious and safe.

    “Home-based cardiac rehabilitation programs were introduced in the early 1980s using ECG transtelephonic monitoring and were found to be efficacious and safe (Fletcher et al., 1984).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Fletcher et al., 1984 source

  • May combine two claims.

    Premisecitation

    Dedicating 'watchers' for continuous rhythm monitoring has been associated with improvement in the fidelity of true rhythm recognition events, including reduction in sustained ventricular tachycardia events.

    “Dedicating”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Cantillon et al., 2016;Funk et al., 1997;Stukshis et al., 1997

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    Telemonitoring can reduce frequency of unnecessary transfers and thus decrease hospital cost.

    “This can reduce frequency of unnecessary transfers and thus decrease hospital cost.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A 2014 national patient safety goal was issued by the Joint Commission requiring hospitals to establish effective alarm management policies by 2016.

    “In recognition, a 2014 national patient safety goal was issued by the Joint Commission requiring hospitals to establish effective alarm management policies by 2016 (The Joint Commission, 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites The Joint Commission, 2014

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    No worrying signs or symptoms were observed during training, nor was it necessary to stop rehabilitation urgently in any patient.

    “In addition, no worrying signs or symptoms were observed during training, nor it was necessary to stop rehabilitation urgently in any patient.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kouidi et al., 2006;Piotrowicz et al., 2010;Smart et al., 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    There are potential benefits of involving patients in their healthcare process, increasing their engagement and compliance with medical therapies and follow-up management.

    “However, there are potential benefits of involving patients in their healthcare process, increasing their engagement and compliance with medical therapies and follow-up management.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims. The quote only partly states this claim.

    Interpretationreasoning

    Given the almost ubiquitous presence of smartphones, downloadable healthcare apps have the potential to be widely used and for unrestricted periods of time, with ability to transmit data over cellular networks or WiFi, breaking the traditional model of AECG monitoring.

    “Given the almost ubiquitous presence of smartphones, downloadable healthcare apps have the potential to be widely used and for unrestricted periods of time, with ability to transmit data over cellular networks or WiFi”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Telemetry findings can be low yield and altered management in only 7% of cases in one study evaluating over 2,000 non-ICU patients.

    “Telemetry findings can be low yield and altered management in only 7% of cases in one study evaluating over 2,000 non-ICU patients (Estrada et al., 1995).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Estrada et al., 1995 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Integrated telemedicine services have the potential to monitor cardiovascular risk factors and to significantly affect morbidity and mortality on a large scale.

    “Thus, integrated telemedicine services by providing surveillance, education, psychological support, and interactive motivational tools have the potential to monitor cardiovascular risk factors and to significantly affect morbidity and mortality on a large scale (Piotrowicz & Piotrowicz, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Piotrowicz & Piotrowicz, 2013 source

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    The rhythm information derived from the large spectrum of AECG recording systems can often lead to appropriate and patient-specific medical and interventional management.

    “The rhythm information derived from the large spectrum of AECG recording systems can often lead to appropriate and patient-specific medical and interventional management.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    As newer devices detect shorter and shorter arrhythmia episodes over longer monitoring periods, the clinical significance of these episodes may be uncertain and clinicians may struggle with decision making for treatments such as anticoagulation.

    “As newer devices detect shorter and shorter arrhythmia episodes over longer monitoring periods, the clinical significance of these episodes may be uncertain and clinicians may struggle with decision making for treatments such as anticoagulation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Novel analytical techniques, such as machine learning, may help to identify patterns of risk not readily apparent simply based on arrhythmia burden or standard multivariate regression techniques.

    “Novel analytical techniques, such as machine learning, may help to identify patterns of risk not readily apparent simply based on arrhythmia burden or standard multivariate regression techniques, particularly if framed using a Bayesian rather than frequentist statistical methodology.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The synthesis of AECG data with other EMR data must be actively performed by the clinical service or practice, leaving great potential for human error.

    “As a result, the synthesis of the AECG data with other EMR data must be actively performed by the clinical service or practice, leaving great potential for human error.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Ablation of the CTI first abolishes the fast pathway and conduction through the CTI switches to the slow pathway, changing the CS activation, which in turn slows the AFL.

    “Ablation of the CTI first abolishes the fast pathway and conduction through the CTI switches to the slow pathway, changing the CS activation, which in turns slows the AFL.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Although most consumer-grade wearable devices are designed to measure heart or pulse rate rather than rhythm, their sensitivity and specificity for heart rate and arrhythmia detection are poorly defined, and there is limited information on their agreement with medical-grade lead-based ECG monitors.

    “Although most of these devices are designed to measure heart or pulse rate rather than rhythm, the sensitivity and specificity for heart rate, let alone, arrhythmia detection, are poorly defined, and there is limited information on the agreement of these devices with medical-grade lead-based ECG monitors (Parak & Korhonen, 2014).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Parak & Korhonen, 2014 source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The committee used all published studies and relevant unpublished information, but was hampered by the relative absence of controlled trials or those that correlated detected arrhythmia with long-term outcome.

    “The committee used all published studies and relevant unpublished information, but was hampered by the relative absence of controlled trials or those that correlated detected arrhythmia with long-term outcome.”
    Quote in the paperSubstantial claim
131 of 131

  • The paper relies on this without support.

    A significant number of low-risk patients with syncope are unnecessarily admitted for further investigation.

    “A significant number of low-risk patients are unnecessarily admitted for further investigation, and a role for outpatient use of AECG can be offered as an alternative.”

  • The paper relies on this without support.

    Poor tolerability of wire-electrode systems, especially when recording is prolonged, and adverse skin reactions challenge patient compliance.

    “Poor tolerability of wire-electrode systems (especially when recording is prolonged) and adverse skin reactions challenge patient compliance.”

  • The paper relies on this without support.

    Failure by the technician or clinician to recognize a genuine arrhythmia episode is significantly more common on the hospital cardiac telemetry service.

    “This problem is significantly more common on the hospital cardiac telemetry service and highlights the need of improved training in the detection and interpretation of AECG of the technical and clinical staff who make up this service (See Section 6).”

  • The paper relies on this without support.

    Most ECG processing algorithms are proprietary, and very few data are available regarding their documented clinical accuracy.

    “Most are proprietary, and very few data are available regarding their documented clinical accuracy.”

  • The paper relies on this without support.

    The majority of artifacts can be recognized from simultaneous multichannel ECG.

    “The majority of artifacts can be recognized from simultaneous multichannel ECG.”

  • The paper relies on this without support.

    Early reperfusion via percutaneous coronary intervention is the critical therapeutic intervention for patients with ST elevation myocardial infarction.

    “In patients suffering ST elevation myocardial infarction (STEMI), early reperfusion via percutaneous coronary intervention (PCI) remains the critical therapeutic intervention.”

  • The paper relies on this without support.

    Most young children (under 5 years) are unable to comply with event-triggered monitoring.

    “Most young children (,5 years) are unable to comply with event triggered monitoring.”

  • The paper relies on this without support.

    Implantation according to current guidelines results in appropriate therapy in only about 20% of patients with ICDs.

    “Implantation according to current guidelines results in appropriate therapy in only about 20% of patients with ICDs.”

  • The paper relies on this without support.

    Current indications neglect the vast majority of patients vulnerable to SCD who have relatively preserved LVEF.

    “In addition, current indications neglect the vast majority of patients vulnerable to SCD who have relatively preserved LVEF.”

  • The paper relies on this without support.

    Suppression of arrhythmia should be considered when a reduction of 75% in isolated or coupled PVCs and 90% in VT episodes had been achieved.

    “Data from 1980s on the value of Holter monitoring in evaluation of efficacy of antiarrhythmic drugs indicated that suppression of arrhythmia should be considered when a reduction of 75% in isolated or coupled PVCs and 90% in VT episodes had been achieved.”

  • The paper relies on this without support.

    There is lower mortality and morbidity with decreased length of stay in hospitals that have adopted the E-ICU.

    “There is a lower mortality and morbidity with a decreased length of stay in hospitals that have adopted the so-called E-ICU.”

  • The paper relies on this without support.

    Vendors' nominal physician notification criteria often overestimate the clinical significance of captured arrhythmias and generate needless calls to physicians and/or Emergency Medical Services.

    “Vendors have established nominal physician notification criteria; these often overestimate the clinical significance of captured arrhythmias and generate needless calls to physicians and/or Emergency Medical Services.”

  • The paper relies on this without support.

    Myopotential inhibition, cross talk, and pacemaker-mediated tachycardia are infrequently encountered in Holter recordings performed in pacemaker patients.

    “Myopotential inhibition, cross talk, and pacemaker-mediated tachycardia, which constitute the major abnormalities in Holter recordings performed in pacemaker patients, are infrequently encountered, and may be detected and notified by remote monitoring, if and when they occur.”

  • The paper relies on this without support.

    Slow VT episodes below detection threshold can only be assessed externally.

    “Furthermore, slow VT episodes below detection threshold can only be assessed externally.”

  • The paper relies on this without support.

    As the number and chronicity of implantable devices increase, the number of patients undergoing explants for device problems and/or infections is increasing.

    “As the number and chronicity of implantable devices increase, the number of patients undergoing explants for device problems and/or infections is increasing.”

  • The paper relies on this without support.

    Responsibility of arrhythmia recognition and notification/escalation is not standardized and varies among hospitals from nursing, to monitoring technicians and even nonclinical personnel in some instances.

    “Responsibility of arrhythmia recognition and notification/escalation is not standardized and varies among hospitals from nursing, to monitoring technicians and even nonclinical personnel in some instances.”

  • The paper relies on this without support.

    Nominal alarm default settings are designed to be highly sensitive so as to not miss a clinically important event, but can also demonstrate poor specificity.

    “Nominal alarm default settings are designed to be highly sensitive so as to not miss a clinically important event, but can also demonstrate poor specificity.”

  • The paper relies on this without support.

    E-ICU has advantages for rural hospitals, decreases transfer to tertiary care hospitals, permits adherence to best critical care practices, and improves patient outcomes.

    “Overall, E-ICU has advantages for rural hospitals, decreases transfer to tertiary care hospitals, permits adherence to best critical care practices, and improves patient outcomes.”

  • The paper relies on this without support.

    There are 3 possible causes of the long RP tachycardia ECG pattern: low atrial tachycardia, fast-slow AV nodal reentrant tachycardia, and a circus movement tachycardia with V-A conduction over a slowly conducting AP.

    “We know of 3 possible causes of that ECG pattern: low atrial tachycardia, fast-slow AV nodal reentrant tachycardia, and a circus movement tachycardia with V-A conduction over a slowly conducting AP.”
19 of 19

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Left-leg electrode placement differs between text and figure

    Minor

    The description of the Mason-Likar lead system places the left-leg electrode on the anterior axillary line, whereas the figure caption places it on the midclavicular line.

  • Central-monitoring outcomes are called unpublished despite a cited publication

    Minor

    The paper says outcomes of central monitoring have not been published, but its reference list includes a 2016 JAMA article specifically about off-site central monitoring and clinical outcomes.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Dąbrowski, 1988, Circadian rhythm of sinoatrial conduction time. A new approach to the study of the sinoatrial node, Cardiovascular World Report, 1, 155
  2. Goldberger, 2007, Journal of the American College of Cardiology, 50, 225, 10.1016/j.jacc.2007.02.071 · DOI · Paper page
  3. International Conference on Harmonisation, 2005, Guidance on E14 Clinical Evaluation of QT/QTc interval prolongation and proarrhythmic potential for non-antiarrhythmic drugs; availability, Federal Register, 70, 61134

Cited by

Sorted by citations

Related

Authors
Steinberg, J. S., Varma, N., Cygankiewicz, I., Aziz, P., Balsam, P., Baranchuk, A., Cantillon, D. J., Dilaveris, P., Dubner, S. J., El-Sherif, N., Krol, J., Kurpesa, M., La Rovere, M. T., Lobodzinski, S. S., Locati, E. T., Mittal, S., Olshansky, B., Piotrowicz, E., Saxon, L., Stone, P. H., Tereshchenko, L., Turitto, G., Wimmer, N. J., Verrier, R. L., Zareba, W., & Piotrowicz, R.
Affiliations
  • University of Rochester Medicine (US)
  • Cleveland Clinic (US)
  • Medical University of Lodz (PL)
  • Medical University of Warsaw (PL)
  • Queen's University (CA)
  • National and Kapodistrian University of Athens (GR)
  • Valley Hospital (US)
  • University of Iowa (US)
  • Institute of Cardiology (PL)
  • University of Southern California (US)
  • Brigham and Women's Hospital (US)
  • Johns Hopkins University (US)
  • NewYork–Presbyterian Brooklyn Methodist Hospital (US)
  • Beth Israel Deaconess Medical Center (US)
Corresponding author
Steinberg, Jonathan S.
ORCID
Venue
Heart Rhythm
Publisher
Elsevier BV
Published
2017-07
Volume
14
Issue
7
Pages
e55-e96
ISSN
1547-5271 (ISSN-L)
DOI
10.1016/j.hrthm.2017.03.038
OpenAlex
W2613494736
Semantic Scholar
3604f971386cfef3ad1d532bfb4219f0c03713a8
Cited by
303
References
318
Citations by year
2026: 27 · 2025: 22 · 2024: 27 · 2023: 32 · 2022: 40 · 2021: 46 · 2020: 40 · 2019: 37 · 2018: 27 · 2017: 4
FWCI
22.78
Type
journal article
Language
en
Update notices
Open access
Licence
Locations
  • Heart Rhythm (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Pfizer
  • State University of New York
  • Cleveland Clinic
  • University of Rochester
  • Boston Scientific Corporation
  • Queen's University
  • Warszawski Uniwersytet Medyczny
  • National and Kapodistrian University of Athens
  • Uniwersytet Łódzki
  • Uniwersytet Warszawski
  • Fondazione Salvatore Maugeri
  • National Institutes of Health
  • SUNY Downstate Medical Center
  • Biosense Webster
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
Holter monitoring, cardiac telemetry, cardiac arrhythmias, arrhythmia detection, heart rate variability

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review