Early Detection of Symptomatic Paroxysmal Cardiac Arrhythmias by Trans-Telephonic ECG Monitoring: Impact on Diagnosis and Treatment of Atrial Fibrillation

TY - JOUR

T1 - Early Detection of Symptomatic Paroxysmal Cardiac Arrhythmias by Trans-Telephonic ECG Monitoring: Impact on Diagnosis and Treatment of Atrial Fibrillation

AU - Anczykowski, Johanna

AU - Willems, Stephan

AU - Hoffmann, Boris A

AU - Meinertz, Thomas

AU - Blankenberg, Stefan

AU - Patten, Monica

N1 - © 2016 Wiley Periodicals, Inc.

PY - 2016/9

Y1 - 2016/9

N2 - INTRODUCTION: Diagnosis of infrequent cardiac arrhythmias (CA) is often unsuccessful using resting or Holter ECG. As early detection and treatment of CA, especially atrial fibrillation (AF), has implications on patients' treatment and outcome, we investigated, whether self-guided, trans-telephonic event-recorder monitoring (Tele-ECG) improves diagnosis and influences treatment options.METHODS: Between 2009 and 2014, 790 patients (54 ± 18 years, 40% male; no history of CA: 582, known AF: 179, other CA: 29) presented with recurrent symptoms suggestive of CA and were screened by Tele-ECG (17.3 ± 26.9 days). A total of 11,775 ECGs were transmitted via a 24-hour telephone hotline including documentation of the respective symptoms.RESULTS: In 73% of patients, CA was documented at the time of symptoms: sinus tachycardia 23%, premature ventricular beats 19%, AF 14%, supraventricular tachycardia 9%, sinus bradycardia 5%, sinus arrhythmia 2%, and AV block II 1%. The mean time until the first symptomatic episode occurred was 6.9 ± 15.3 days (median 2.5 days). The first documented arrhythmia occurred on average after 7.7 ± 14.1 days (median 3 days). In patients with AF (n = 110), 44% was newly diagnosed. According to the Tele-ECG diagnosis, AF ablation was performed in 27% of these patients, 7% electrical cardioversion, and in 30% antiarrhythmic therapy was initiated. In 65% of the patients with recurrence of known AF, (re-)ablation was performed or recommended and in 16% antiarrhythmic therapy was modified.CONCLUSIONS: Tele-ECG monitoring is effective in the diagnosis of suspected symptomatic CA. A diagnosis can usually be achieved within 1 week and has implications on patients' care.

AB - INTRODUCTION: Diagnosis of infrequent cardiac arrhythmias (CA) is often unsuccessful using resting or Holter ECG. As early detection and treatment of CA, especially atrial fibrillation (AF), has implications on patients' treatment and outcome, we investigated, whether self-guided, trans-telephonic event-recorder monitoring (Tele-ECG) improves diagnosis and influences treatment options.METHODS: Between 2009 and 2014, 790 patients (54 ± 18 years, 40% male; no history of CA: 582, known AF: 179, other CA: 29) presented with recurrent symptoms suggestive of CA and were screened by Tele-ECG (17.3 ± 26.9 days). A total of 11,775 ECGs were transmitted via a 24-hour telephone hotline including documentation of the respective symptoms.RESULTS: In 73% of patients, CA was documented at the time of symptoms: sinus tachycardia 23%, premature ventricular beats 19%, AF 14%, supraventricular tachycardia 9%, sinus bradycardia 5%, sinus arrhythmia 2%, and AV block II 1%. The mean time until the first symptomatic episode occurred was 6.9 ± 15.3 days (median 2.5 days). The first documented arrhythmia occurred on average after 7.7 ± 14.1 days (median 3 days). In patients with AF (n = 110), 44% was newly diagnosed. According to the Tele-ECG diagnosis, AF ablation was performed in 27% of these patients, 7% electrical cardioversion, and in 30% antiarrhythmic therapy was initiated. In 65% of the patients with recurrence of known AF, (re-)ablation was performed or recommended and in 16% antiarrhythmic therapy was modified.CONCLUSIONS: Tele-ECG monitoring is effective in the diagnosis of suspected symptomatic CA. A diagnosis can usually be achieved within 1 week and has implications on patients' care.

KW - Action Potentials

KW - Adult

KW - Aged

KW - Anti-Arrhythmia Agents/therapeutic use

KW - Arrhythmias, Cardiac/diagnosis

KW - Atrial Fibrillation/diagnosis

KW - Catheter Ablation

KW - Early Diagnosis

KW - Electric Countershock

KW - Electrocardiography/instrumentation

KW - Female

KW - Heart Conduction System/physiopathology

KW - Heart Rate

KW - Hotlines

KW - Humans

KW - Male

KW - Middle Aged

KW - Predictive Value of Tests

KW - Recurrence

KW - Reoperation

KW - Telemedicine/instrumentation

KW - Telemetry/instrumentation

KW - Telephone

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1111/jce.13025

DO - 10.1111/jce.13025

M3 - SCORING: Journal article

C2 - 27257094

VL - 27

SP - 1032

EP - 1037

JO - J CARDIOVASC ELECTR

JF - J CARDIOVASC ELECTR

SN - 1045-3873

IS - 9

ER -