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

In the paper

“in contradistinction to what is reported in patients with ischemic cardiomyopathy, the prognostic value of AECG in NIDCM is rather low and remains controversial”

What the sources say

• Disputed

  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.

  cites Goldberger et al., 2007 sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  cites Goldberger et al., 2014 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites Pedersen et al., 2014 source

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, 1996
• Disputed

  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.

  cites Sassi et al., 2015 sourceExperimental — accuracy not yet measured
• Disputed

  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.

  cites Wellens et al., 2014 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• ?Could not verify

  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)

  cites Epstein et al., 2013 sourceExperimental — accuracy not yet measured

In the paper

“There have been major advances in recording and signal processing techniques resulting in enhanced recording fidelity and more sophisticated analysis software (Kennedy, 2006).”

What the sources say

• Supported

  The Abstract describes recording advances that improved low-frequency response and reliability. Its “Holter Electrocardiographic Parameters” passage describes digital signal processing, a shift to software-driven technology, and improved detection algorithms. Together, these support the claim; no page numbers are provided in our copy. (LLM, conf=0.90)

  cites Kennedy, 2006 source

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites Scirica et al., 2010 sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• Partly supported

  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)

  cites Buxton et al., 1999 sourceExperimental — accuracy not yet measured
• ?Could not verify

  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)

  cites Epstein et al., 2013 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites Priori et al., 2015 source

In the paper

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

What the sources say

• Partly supported

  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)

  cites Baumgartner et al., 2010 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites Khairy et al., 2014 source

In the paper

“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.”

What the sources say

• Partly supported

  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)

  cites Scirica et al., 2010 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites Monahan et al., 2009 sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• Supported

  Section 5.3 reports paroxysmal supraventricular arrhythmias in up to 38% of patients with HCM during ambulatory ECG monitoring. Sections 8.3 and 9.4.1 say atrial arrhythmias can occasionally precipitate syncope and that new-onset AF is frequently associated with heart-failure symptoms. (LLM, conf=0.88)

  cites Elliott et al., 2014 source
• Partly supported

  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)

  cites Gersh et al., 2011 sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• Supported

  The ICD therapy and follow-up section reports that NSVT and a Holter PVC count >1,000/24 h predicted appropriate ICD therapy in univariate analysis. The PVC count had a hazard ratio of 3.1, matching the claim of over threefold higher risk. Only NSVT remained a significant predictor in multivariable analysis, consistent with the claim’s cautious wording, ‘may predict.’ (LLM, conf=0.93)

  cites Bhonsale et al., 2011 source

In the paper

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

What the sources say

• Supported

  Table 2 (shown under Conclusions; page not specified in the copy) reports NSVT negative predictive accuracy of 90.3% and positive predictive accuracy of 20.7%. These support the citing sentence's approximate values of 90% and 20%. (LLM, conf=0.94)

  cites Goldberger et al., 2014 source

In the paper

“Nevertheless, NSVT is characterized by high negative (95%) but low positive predictive values”

What the sources say

• Supported

  The ‘Relation of ventricular arrhythmia to outcome’ section reports that NSVT on Holter had a 95% negative predictive value and a 9% positive predictive value for sudden death in the studied HCM cohort. Table 3 gives the same values. (LLM, conf=0.95)

  cites Adabag et al., 2005 source

In the paper

“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.”

What the sources say

• Partly supported

  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)

  cites Iacoviello et al., 2007 sourceExperimental — accuracy not yet measured

In the paper

“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”

What the sources say

• Supported

  The Discussion states that atrial fibrillation/flutter in patients with ARVD is associated with inappropriate ICD shocks, heart transplantation, and cardiac death. The Arrhythmia Detection and Clinical Implications section also emphasizes detecting these arrhythmias and reports inappropriate shocks during follow-up. (LLM, conf=0.94)

  cites Saguner et al., 2014 source

In the paper

“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).”

What the sources say

• Partly supported

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

  cites Bauer et al., 2008 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites Cygankiewicz et al., 2009 source
• ?Not checked — no full text of the sourcecites La Rovere et al., 2012 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Schmidt et al., 1999 source
• Supported

  The Physiologic Background and Pathophysiology of HRT section (page not provided) describes early acceleration and later deceleration after ventricular premature complexes as compatible with baroreflex physiology. It also reports that HRT measures correlate with baroreflex sensitivity, supporting the claim that HRT is an indicator of it. (LLM, conf=0.92)

  cites Bauer et al., 2008 source

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites Barrett et al., 2014 sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  cites Rosenberg et al., 2013 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites Rothman et al., 2007 source

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites Kennedy, 2015 sourceExperimental — accuracy not yet measured

In the paper

“AECG facilitates detection, quantification, and morphology assessment for the evaluation of the overall PVC burden as a potential cause of”

What the sources say

• ?Not checked — no full text of the sourcecites Baman et al., 2010 source
• Supported

  The “Electrocardiography, Holter monitoring, and other monitoring” section says ambulatory Holter monitoring detects and quantifies PVCs and records cardiac rhythm alongside a patient symptom diary. The “Tachycardia-related cardiomyopathy” section links PVC burden and morphologic features to cardiomyopathy and calls for evaluating ECGs and rhythm strips. Together, these passages support the attributed uses of ambulatory ECG monitoring. (LLM, conf=0.87)

  cites Cantillon, 2013 source
• Partly supported

  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)

  cites Zipes et al., 2006 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Andrikopoulos et al., 2010 source
• ?Not checked — no full text of the sourcecites Barold, 1998 source
• Supported

  The paper’s opening section says remote-capable implantable devices permit assessment of cardiac rhythm and device function. “Devices Currently Amenable of Remote Monitoring” identifies pacemakers, ICDs, and CRTs; “Diagnosis of Symptomatic and Asymptomatic Events” describes remote detection of lead and generator problems as well as arrhythmia notifications. The supplied copy does not provide page numbers for these passages. (LLM, conf=0.93)

  cites Dubner et al., 2012 source

In the paper

“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).”

What the sources say

• Supported

  The Joshi citation attaches to the first clause, not the claim about additional procedures or drugs. In Predictors of Recurrence, the paper reports that AF recurrence within two weeks had a positive predictive value of 54% for recurrence at 12 months, supporting the hedged claim that very early events may predict long-term failure. (LLM, conf=0.90)

  cites Joshi et al., 2009 source
• Partly supported

  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)

  cites Arya et al., 2010 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites Gladstone et al., 2014 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Haverkamp et al., 2000 source
• ?Not checked — no full text of the sourcecites Moss, 1999 source
• Partly supported

  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)

  cites Zareba et al., 1995 sourceExperimental — accuracy not yet measured

In the paper

“Indeed, catheter ablation may increase the proportion of AF events that are asymptomatic, probably by alteration of cardiac neural element (Hindricks et al., 2005).”

What the sources say

• Partly supported

  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)

  cites Hindricks et al., 2005 sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• ?Could not verify

  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)

  cites Marini et al., 2005 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites Drew et al., 2004 sourceExperimental — accuracy not yet measured

In the paper

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

In the paper

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

In the paper

“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).”

In the paper

“Continuing ablation of the slower pathway terminates the AFL.”

In the paper

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

In the paper

“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.”

In the paper

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

In the paper

“Generally speaking, the higher the number of the leads the higher the complex detection precision.”

In the paper

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

In the paper

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

In the paper

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

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Krasnow & Bloomfield, 1976 source

In the paper

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

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites Lobodzinski, 2013 source
• ?Not matched

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

  cites Lobodzinski & Laks, 2008, 2012
• ?Not checked — no full text of the sourcecites Perez de Isla et al., 2011 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Papouchado, Walker, James, & Clarke, 1987 source

In the paper

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

In the paper

“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.”

In the paper

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

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites Locati, 2002 source

In the paper

“The developers usually use the annotated MIT-BIH ECG and arrhythmia databases available on physionet.orgto tune their algorithms (George & Roger, 2001).”

What the sources say

• ?Not matched

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

  cites George & Roger, 2001

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Watanabe et al., 2014 source

In the paper

“AECG monitoring is only one component of the investigation and most useful if recorded during symptoms.”

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

“Up to 20% of outpatients present with palpitations and most of the cases have benign causes (Kroenke, Arrington, & Mangelsdorff, 1990).”

What the sources say

• ?Not matched

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

  cites Kroenke, Arrington, & Mangelsdorff, 1990

In the paper

“The Danish health system has formally implemented such a system for several years, processing about 4,000 ECGs per year”

What the sources say

• ?Not checked — no full text of the sourcecites Clemmensen et al., 2013 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Bass et al., 1990 source

In the paper

“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”

In the paper

“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.”

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Weber & Kapoor, 1996 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Birnbaum et al., 2014 source

In the paper

“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.”

In the paper

“confirming technical feasibility and suggesting measurable clinical impact”

In the paper

“Typically, diagnosed rhythms reflect prevalence of arrhythmias in the studied populations (Table 2).”

In the paper

“The relevance of identified spontaneous arrhythmias to the palpitations is variable and could be low (Lok & Lau, 1996;Zeldis, Levine, Michelson, & Morganroth, 1980).”

What the sources say

• ?Not checked — no full text of the sourcecites Lok & Lau, 1996 source
• ?Not checked — no full text of the sourcecites Zeldis, Levine, Michelson, & Morganroth, 1980 source

In the paper

“Continuousloop recorders provided higher diagnostic yield, as compared to 24-hr Holter, and have proved to be more cost-effective (Fogel, Evans, & Prystowsky, 1997).”

What the sources say

• ?Not checked — no full text of the sourcecites Fogel, Evans, & Prystowsky, 1997 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Morillo & Baranchuk, 2004 source

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

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

What the sources say

• ?Not checked — no full text of the sourcecites Hohnloser et al., 1999 source

In the paper

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

What the sources say

• ?Not matched

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

  cites Pediatric and Congenital Electrophysiology Society [PACES] et al., 2012

In the paper

“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.”

In the paper

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

What the sources say

• ?Not checked — no full text of the sourcecites Crawford et al., 1999 source

In the paper

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

In the paper

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

In the paper

“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%.”

What the sources say

• ?Not checked — no full text of the sourcecites Camm et al., 2015 source

In the paper

“However, for many competitive athletes, the sport itself is required to initiate the symptom and potentially the arrhythmia.”

In the paper

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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites Grimm, Christ, Bach, M€ uller, & Maisch, 2003 source

In the paper

“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.”

In the paper

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

In the paper

“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.”

In the paper

“It detects autonomic nervous system tone based on beat-to-beat RR intervals.”

In the paper

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

In the paper

“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)).”

What the sources say

• ?Not checked — no full text of the sourcecites La Rovere et al., 2003 source
• ?Not checked — no full text of the sourcecites La Rovere et al., 2012 source

In the paper

“Nonlinear HRV analysis is believed to be less dependent on preprocessing and to express better the complexity of RR changes (Perkiomaki et al., 2000).”

What the sources say

• ?Not checked — no full text of the sourcecites Perkiomaki et al., 2000 source

In the paper

“In addition, the type of monitoring depends on the type of athletic participation and the arrhythmia and symptom being assessed.”

In the paper

“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.”

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites Cygankiewicz et al., 2008
• ?Not checked — no full text of the sourcecites La Rovere et al., 2012 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Makikallio et al., 2005 source

In the paper

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

In the paper

“Only Holter recordings with 5 PVCs are considered reliable for HRT calculation.”

In the paper

“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.”

In the paper

“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%.”

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Chevalier et al., 2002s source
• ?Not matched

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

  cites Cygankiewicz et al., 2008
• ?Not checked — no full text of the sourcecites Fujiki et al., 2004 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites La Rovere et al., 2012 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Dobson et al., 2013 source

In the paper

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

In the paper

“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.”

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Pedersen et al., 2014 source

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites Calkins et al., 2012 source

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites Calkins et al., 2012 source

In the paper

“Most antiarrhythmic drugs also exert negative chronotropic and dromotropic effects.”

In the paper

“since sudden death occurs largely in subjects in whom left ventricular ejection fraction has proven insufficient for risk stratification.”

In the paper

“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.”

In the paper

“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.”

In the paper

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

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Kishore et al., 2014 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Drew & Krucoff, 1999 source

In the paper

“Conversely, serious adverse events including death have resulted from alarm fatigue, and these are likely heavily under-reported (Pennsylvania Patient Safety Authority, 2008).”

What the sources say

• ?Not matched

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

  cites Pennsylvania Patient Safety Authority, 2008

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites Haberman et al. 2015;Lowres et al., 2014;Nguyen et al., 2015

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites Kouidi et al., 2006;Piotrowicz et al., 2010;Smart et al., 2005

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites Inglis et al., 2011;Chaudhry et al., 2010;Koehler et al., 2011

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Pettersen et al., 2014 source

In the paper

“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.”

What the sources say

• ?Not matched

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

  cites Kouidi et al., 2006;Piotrowicz et al., 2010;Smart et al., 2005

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Kutyifa et al., 2015 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Fletcher et al., 1984 source

In the paper

“Dedicating”

What the sources say

• ?Not matched

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

  cites Cantillon et al., 2016;Funk et al., 1997;Stukshis et al., 1997

In the paper

“This can reduce frequency of unnecessary transfers and thus decrease hospital cost.”

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites The Joint Commission, 2014

In the paper

“In addition, no worrying signs or symptoms were observed during training, nor it was necessary to stop rehabilitation urgently in any patient.”

What the sources say

• ?Not matched

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

  cites Kouidi et al., 2006;Piotrowicz et al., 2010;Smart et al., 2005

In the paper

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

In the paper

“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”

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Estrada et al., 1995 source

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Piotrowicz & Piotrowicz, 2013 source

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites Parak & Korhonen, 2014 source

In the paper

“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.”