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High-Risk Arrhythmias Detected Outside of Traditional 24- to 48-Hour Monitoring Window with the Use of New Tech-Enabled Heart Monitors

A Kaiser Permanente Northern California study of the clinical utility of a novel, wireless electrocardiographic monitor that can store up to 14 days of recording found that a meaningful percentage of potentially high-risk cardiac arrhythmias were identified after the initial 24- to 48-hour window that is often used for traditional monitors. The study published today in BioMed Central Cardiovascular Disorders.

Ambulatory electrocardiographic (ECG) monitoring is the standard of care to screen symptomatic outpatient adults for high-risk ventricular and atrial arrhythmias. Recent technological advances have allowed for higher fidelity recording and larger storage capacities that are able to capture full disclosure ECG recordings beyond the traditional 24- or 48-hour monitoring periods.

To understand the applicability in day-to-day clinical practice, researchers evaluated results from a long-term ambulatory ECG monitoring system to measure the burden and timing of potentially high-risk arrhythmias, including ventricular tachycardia, high-grade heart block and clinically significant pauses in atrioventricular conduction.

The study analyzed national data from the iRhythm ZIO® Service for 122,815 long-term continuous ambulatory monitors prescribed from 2011-2013. The ZIO® Patch is a lightweight, lead-wire free, single-patient-use ECG monitor that adheres to the left upper chest and records and stores up to 14 days of continuous, beat-to-beat ECG.

“The research highlights that uncommon but potentially serious arrhythmias were detected with longer-term continuous ECG monitoring using this non-invasive approach,” said senior author Alan S. Go, MD, Chief, Cardiovascular and Metabolic Conditions Research, at the Kaiser Permanente Division of Research. Additional efforts are needed to determine if detecting these arrhythmias that may be missed using other monitoring strategies leads to better patient outcomes by earlier evaluation and management.”

Across all studied high-risk arrhythmias, there was an incrementally higher detection of potentially high-risk arrhythmias with longer continuous ambulatory ECG monitoring during the 14-day maximum monitoring period. The study found that for ventricular arrhythmias, one- to two-thirds were observed after the initial 48 hours of monitoring, while more than half of potentially serious bradyarrhythmias were identified more than 48 hours after monitoring.

“Our finding that longer monitoring increases the diagnostic yield for these clinically meaningful arrhythmias can help guide physicians when deciding between different ambulatory monitoring systems with varying capabilities,” noted lead author Matthew D. Solomon, MD, PhD, Department of Cardiology, Kaiser Permanente Oakland Medical Center, and Adjunct Investigator at the Kaiser Permanente Division of Research. “Future research should examine the clinical utility of improved high-risk arrhythmia detection in targeted patient groups and its impact on patient management and associated clinical outcomes.”

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