62 Prolonged, Intermittent Monitoring using a Handheld ECG Significantly Increases the Diagnostic Yield of Paroxysmal Atrial Fibrillation

Abstract

Purpose: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Paroxysmal AF (PAF) comprises half of AF cases and confers an equivalent risk of stroke to sustained AF. However, PAF poses a diagnostic challenge given its variable frequency, potential brevity and frequent lack of symptoms. We aim to determine whether the extended, intermittent use of a handheld ECG monitor improves the diagnosis of PAF. Methods: Patients meeting these criteria entered into the study: suspected PAF (palpitations or irregular pulse); aged ≥ 40 years; no previously documented AF. Participants wore an automated cardiac event recorder for 1-week (R Test Evolution 4, Novacor). They also used a handheld ECG monitor (OMRON® Portable ECG Monitor), recording 30-second segments twice-daily for 12 weeks. Results: We recruited 143 participants (mean age 66 years; 63% female). 83% presented with palpitations and 17% with an irregular pulse. 90% of participants completed the study. Atrial arrhythmias were detected in 33 patients (23%): 27 were diagnosed with PAF, 5 with atrial flutter and 1 with atrial tachycardia. 24% of cases were identified using the cardiac event recorder, 45% using the handheld ECG and 30% with both (p = 0.32). Significantly more PAF cases were detected over 12-weeks compared to 24-hours (n = 33 vs 6; p = 0.0001, Fisher's exact test) and 1-week (n = 33 vs 18; p = 0.015). Conclusions: The intermittent use of a handheld ECG monitor over 12-weeks significantly increases the diagnosis of PAF compared to standard investigations. We suggest that the duration of monitoring used in current practice is accordingly extended. (Figure presented).