TY - JOUR
T1 - Screening for paroxysmal atrial fibrillation in primary care using Holter monitoring and intermittent, ambulatory single-lead electrocardiography
AU - Karregat, Evert P. M.
AU - Gurp, Nicole Verbiest-van
AU - Bouwman, Anne C.
AU - Uittenbogaart, Steven B.
AU - Himmelreich, Jelle C. L.
AU - Lucassen, Wim A. M.
AU - Krul, Sébastien P. J.
AU - van Kesteren, Henri A. M.
AU - Luermans, Justin G. L. M.
AU - van Weert, Henk C. P. M.
AU - Stoffers, Henri E. J. H.
N1 - Funding Information: This work was supported by ZonMw (The Netherlands Organisation for Health Research and Development) [grant number 839110006] and complemented with university funds. The MyDiagnosticks were partly provided on loan from Boehringer and partly bought against reduced charges from the manufacturer (Applied Biomedical Systems?, Maastricht, The Netherlands). Funding Information: This work was supported by ZonMw (The Netherlands Organisation for Health Research and Development) [grant number 839110006 ] and complemented with university funds. The MyDiagnosticks were partly provided on loan from Boehringer and partly bought against reduced charges from the manufacturer (Applied Biomedical Systems®, Maastricht, The Netherlands). Publisher Copyright: © 2021 The Author(s)
PY - 2021/12/15
Y1 - 2021/12/15
N2 - Background: Timely detection of atrial fibrillation (AF) is important because of its increased risk of thrombo-embolic events. Single time point screening interventions fall short in detection of paroxysmal AF, which requires prolonged electrocardiographic monitoring, usually using a Holter. However, traditional 24-48 h Holter monitoring is less appropriate for screening purposes because of its low diagnostic yield. Intermittent, ambulatory screening using a single-lead electrocardiogram (1 L-ECG) device can offer a more efficient alternative. Methods: Primary care patients of ≥65 years participated in an opportunistic screening study for AF. We invited patients with a negative 12 L-ECG to wear a Holter monitor for two weeks and to use a MyDiagnostick 1 L-ECG device thrice daily. We report the yield of paroxysmal AF found by Holter monitoring and calculate the diagnostic accuracy of the 1 L-ECG device's built-in AF detection algorithm with the Holter monitor as reference standard. Results: We included 270 patients, of whom four had AF in a median of 8.0 days of Holter monitoring, a diagnostic yield of 1.5% (95%-CI: 0.4–3.8%). In 205 patients we performed simultaneous 1 L-ECG screening. For diagnosing AF based on the 1 L-ECG device's AF detection algorithm, sensitivity was 66.7% (95%-CI: 9.4–99.2%), specificity 68.8% (95%-CI: 61.9–75.1%), positive predictive value 3.1% (95%-CI: 1.4–6.8%) and negative predictive value 99.3% (95%-CI: 96.6–99.9%). Conclusion: We found a low diagnostic yield of paroxysmal AF using Holter monitoring in elderly primary care patients with a negative 12 L-ECG. The diagnostic accuracy of an intermittently, ambulatory used MyDiagnostick 1 L-ECG device as interpreted by its built-in AF detection algorithm is limited.
AB - Background: Timely detection of atrial fibrillation (AF) is important because of its increased risk of thrombo-embolic events. Single time point screening interventions fall short in detection of paroxysmal AF, which requires prolonged electrocardiographic monitoring, usually using a Holter. However, traditional 24-48 h Holter monitoring is less appropriate for screening purposes because of its low diagnostic yield. Intermittent, ambulatory screening using a single-lead electrocardiogram (1 L-ECG) device can offer a more efficient alternative. Methods: Primary care patients of ≥65 years participated in an opportunistic screening study for AF. We invited patients with a negative 12 L-ECG to wear a Holter monitor for two weeks and to use a MyDiagnostick 1 L-ECG device thrice daily. We report the yield of paroxysmal AF found by Holter monitoring and calculate the diagnostic accuracy of the 1 L-ECG device's built-in AF detection algorithm with the Holter monitor as reference standard. Results: We included 270 patients, of whom four had AF in a median of 8.0 days of Holter monitoring, a diagnostic yield of 1.5% (95%-CI: 0.4–3.8%). In 205 patients we performed simultaneous 1 L-ECG screening. For diagnosing AF based on the 1 L-ECG device's AF detection algorithm, sensitivity was 66.7% (95%-CI: 9.4–99.2%), specificity 68.8% (95%-CI: 61.9–75.1%), positive predictive value 3.1% (95%-CI: 1.4–6.8%) and negative predictive value 99.3% (95%-CI: 96.6–99.9%). Conclusion: We found a low diagnostic yield of paroxysmal AF using Holter monitoring in elderly primary care patients with a negative 12 L-ECG. The diagnostic accuracy of an intermittently, ambulatory used MyDiagnostick 1 L-ECG device as interpreted by its built-in AF detection algorithm is limited.
KW - Atrial fibrillation
KW - Diagnostic accuracy
KW - Electrocardiography
KW - Holter monitoring
KW - Prevalence
KW - Screening
UR - http://www.scopus.com/inward/record.url?scp=85118235056&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ijcard.2021.10.021
DO - https://doi.org/10.1016/j.ijcard.2021.10.021
M3 - Article
C2 - 34687805
SN - 0167-5273
VL - 345
SP - 41
EP - 46
JO - International journal of cardiology
JF - International journal of cardiology
ER -