Document Detail


Comparison of continuous versus intermittent monitoring of atrial arrhythmias.
MedLine Citation:
PMID:  17161787     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The ability of intermittent or symptom-based monitoring to accurately identify patients with atrial tachycardia/atrial fibrillation (AT/AF) and to quantify AT/AF burden is not well established. OBJECTIVES: The purpose of this study was to compare intermittent and symptom-based monitoring to continuous monitoring for (1) identification of patients with any AT/AF, (2) identification of patients with long-duration AT/AF, and (3) assessment of AT/AF burden. METHODS: Data from 574 pacemaker (AT500, Medtronic) patients were analyzed retrospectively over 1 year. The device recorded the amount of AT/AF detected each day. Intermittent monitoring (annual, quarterly, and monthly 24-hour Holter; 7-day and 30-day annual long-term recordings) was simulated by analyzing data from randomly selected days within a prescribed monitoring window. Symptom-based monitoring was approximated by analyzing days when patients indicated symptoms with an external activator. RESULTS: All intermittent and symptom-based monitoring resulted in significantly lower sensitivity (range 31%-71%) and negative predictive value (range 21%-39%) for identification of patients with any AT/AF (P <.001) and underestimated AT/AF burden (P <.001) compared with continuous monitoring. Sensitivity for identifying patients with long-duration episodes ranged from 23% to 58% (P <.001 vs continuous monitoring). Identification of patients with AT/AF and assessment of AT/AF burden with intermittent monitoring depended on the patient's actual AT/AF burden and improved with increasing frequency or duration of intermittent monitoring. CONCLUSION: Intermittent and symptom-based monitoring is highly inaccurate for identifying patients with any or long-duration AT/AF and for assessing AT/AF burden. Further investigation is required to determine if full AT/AF disclosure with implantable devices is effective in reducing stroke risk and facilitating maintenance of sinus rhythm.
Authors:
Paul D Ziegler; Jodi L Koehler; Rahul Mehra
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2006-08-03
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  3     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-12-12     Completed Date:  2007-02-23     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1445-52     Citation Subset:  IM    
Affiliation:
Medtronic Inc., Minneapolis, Minnesota. paul.david.ziegler@medtronic.com <paul.david.ziegler@medtronic.com>
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MeSH Terms
Descriptor/Qualifier:
Aged
Atrial Fibrillation / diagnosis,  physiopathology*,  therapy
Cardiac Pacing, Artificial
Defibrillators, Implantable*
Electrocardiography, Ambulatory / methods*
Female
Follow-Up Studies
Heart Conduction System / physiopathology*
Humans
Male
Predictive Value of Tests
Research Design
Retrospective Studies
Sensitivity and Specificity
Tachycardia, Supraventricular / diagnosis,  physiopathology*,  therapy
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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