Patch-based cardiac rhythm monitoring more accurately detects arrhythmias than multi- electrode system
Presenter: Lohit Garg, MD, University of Pennsylvania, Philadelphia, PA
Comparison of patch versus multi-electrode cardiac monitoring for the detection of arrhythmias: The COMPARE study. Abstract 1801-142.
An ambulatory patch-based cardiac rhythm monitoring system provides more reliable arrhythmia monitoring and more accurate determination of atrial fibrillation than a multi- electrode, wire-based monitoring system, according to recently released study data presented by Lohit Garg, MD, University of Pennsylvania, Philadelphia, PA.
Ambulatory rhythm monitoring for the detection of cardiac arrhythmias is standard practice in electrophysiology, he said. Clinicians can select from a variety of different monitors, including multi-electrode, wire-based monitors, which generally use 3 electrodes, or patch-based monitors.
The prospective COMPARE trial aimed to compare quality measures such as wear times, arrhythmia detection, and other quality measures between 2 forms of cardiac monitoring: a multi-electrode monitoring unit (Philips BioTelemetry) and the Zio XT patch monitor (iRhythm Technologies). The 17-month study included 50 patients (mean age 59 years; 74% men) who were referred for mobile cardiac telemetry for the evaluation of arrhythmias. The 2 monitoring systems were placed simultaneously by study personnel. The monitoring systems and arrhythmia detection were compared during a 14-day period.
The most common indications for monitoring were to evaluate atrial fibrillations post-ablation (76%) and palpitations (20%). In addition, the researchers collected monitoring data on wearable and analyzable times; presence of supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, and heart block; and heart rate trends.
“Patients wore the patch longer (mean 13.4 days) than the 3-electrode monitoring system (mean 12.7 days),” Garg noted. “Also, the analyzable time was higher for the patch-based monitor (mean 95%) than the 3-electrode system (mean 85%).” Both results were statistically significant.
The quality of tracings appeared better with the patch than the 3-electrode system. There were 15 patients who had paroxysmal atrial fibrillation. In 14 of those patients, both monitors identified a similar burden of atrial fibrillation. One patient was inappropriately labeled as sinus rhythm, and thus inaccurately calculated the atrial fibrillation burden. Two other patients had lower analyzable time with the 3-electrode system and therefore had inaccurate detection of atrial fibrillation burden.
Additional quality control evaluated the average number of days per patient with at least 4 hours of missing heart rate data. The patch had fewer missing data days (0.3 days) than the 3- electrode system (6.5 days; P < .001).
There were no differences in identification of other arrhythmias, including heart block, supraventricular tachycardia, or ventricular arrhythmias.
In conclusion, Garg said: “The patch device had significantly more monitoring and analyzable data than the 3-electrode device. In particular, we identified 2 more days of data capture with the patch than the multi-electrode device over the 14-day monitoring period. More reliable monitoring allows for more accurate determination of atrial fibrillation burden. And the quality of the data obtained with the patch monitor was better than the multi-electrode monitor as suggested by missing heart rate trends in excess of 4 hours per day.”
The researchers did not observe any non-atrial fibrillation arrhythmias in these patients and, therefore, could not compare the 2 monitoring strategies for detection of atrioventricular block, supraventricular tachycardia, ventricular tachycardia, or ventricular fibrillation.
“This study indicates that physicians should consider patient compliance, missing data, and heart rate trends when considering ambulatory electrocardiographic monitoring,” Garg added.
References
Barrett PM, Komatireddy R, Haaser S, et al. Comparison of 24-hour Holter monitoring with 14- day novel adhesive patch electrocardiographic monitoring. Am J Med 2014; 127(1):95.e11-7. doi:10.1016/j.amjmed.2013.10.003
Garg, L, Schaller, R, Kumareswaran, R, et al. Comparison of patch versus multi-electrode cardiac monitoring for the detection of arrhythmias: the COMPARE study. J Am Coll Cardiol 2023; 8 (8 Suppl 7):261. https://doi.org/10.1016/S0735-1097(23)00705-2
Disclosures
Lohit Garg: Nothing to disclose.