Value of Extended Arrhythmia Screening inAdult Congenital Heart Disease Patients

Abstract

The European Society of Cardiology guidelines for the management ofadult congenital heart disease patients recommend screening forarrhythmias and bradycardias in symptomatic patients, often being doneby means of an ambulatory 24-48-hour Holter or implantable looprecorder (ILR). However, nowadays non-invasive instruments, such aspatches, smartwatches and smartphones based on single-lead ECGsthat perform extended monitoring, are also available. The aim of thisnarrative review was to assess whether these instruments, when theydetect arrhythmias and bradycardias in patients with adult congenitalheart disease, will lead to meaningful changes in clinical care. Clinicallymeaningful changes include adjustment of medication, cardioversion,electrophysiology study, ablation or implantation of a cardiovascularimplantable electronic device. The following monitoring instruments are discussed: cumulative Holter, 2-week continuous monitor, smartwatchand smartphone-based single-lead ECG, and ILR. The diagnostic yield of extended rhythm monitoring is high, and varies between 18% (smartphone-based single-lead ECG) and 41% with ILR. In conclusion, contemporary arrhythmia screening includes various new non-invasive technologies that are promising new tools as an alternative to Holter monitoring or ILR. However, the optimal mode of detection is still unclear due to the lack of head-to-head comparisons.