Continuous ECG Monitoring V. Mobile Telemetry: A Comparison of Arrhythmia Diagnostics

Introduction: A myriad of long-term (>48 hr) cardiac rhythm monitors are available for use. Clinicians rarely scrutinize the full disclosure and thus rely on manufacturers to detect and report relevant rhythm abnormalities using processes that are opaque to most providers. This study compares the diagnostic accuracy between mobile cardiac telemetry (MCT) and long term continuous ECG monitoring. Methods: In an outpatient arrhythmia clinic, 50 sequential patients ordered to wear a 30-day MCT were enrolled to simultaneously wear a continuous ECG monitor. Periods of concomitant wear of both devices were examined. Studies were reviewed by two electrophysiologists and categorized according to whether significant clinical arrhythmias were identified and correctly diagnosed. Results: Of the 50 patients enrolled, 46 wore both monitors simultaneously for an average time of simultaneous recording of 10.3 ± 4.4 days. During simultaneous recording, significant arrhythmias were diagnosed by the MCT in 11/46 patients (24%) compared with 23/46 (50%) patients p=0.018, by continuous ECG monitoring. Thus, in 12 of 46 patients (26%), a significant arrhythmia finding was captured by the long-term ECG and missed by the MCT. Long term continuous ECG captured several rhythms which were misreported or unreported by MCT including AV node re-entry in two patients, second degree AV block in three patients, VT in 6 patients, and captured 4 additional AF episodes missed by MCT. Conclusions: In a time-controlled, paired analysis of two disparate rhythm monitors worn simultaneously, human review of long-term continuous ECG recordings significantly outperformed algorithm-dependent MCT monitor's ability to detect significant arrhythmias.