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  • Detection of unknown atrial fibrillation by prolonged ECG monitoring in an all-comer patient cohort and association with clinical and Holter variables

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Arrhythmias and sudden death
Original research
Detection of unknown atrial fibrillation by prolonged ECG monitoring in an all-comer patient cohort and association with clinical and Holter variables
  1. Muhammad Jawad-Ul-Qamar1,2,
  2. Winnie Chua1,
  3. Yanish Purmah1,2,
  4. Mohammad Nawaz2,
  5. Chetan Varma2,
  6. Russell Davis2,
  7. Abdul Maher2,
  8. Larissa Fabritz1,2 and
  9. Paulus Kirchhof1,2,3
  1. 1Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
  2. 2Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
  3. 3University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
  1. Correspondence to Professor Paulus Kirchhof; p.kirchhof{at}bham.ac.uk

Abstract

Objectives Prolonged ECG monitoring is clinically useful to detect unknown atrial fibrillation (AF) in stroke survivors. The diagnostic yield of prolonged ECG monitoring in other patient populations is less well characterised. We therefore studied the diagnostic yield of prolonged Holter ECG monitoring for AF in an unselected patient cohort referred from primary care or seen in a teaching hospital.

Methods We analysed consecutive 7-day ECG recordings in unselected patients referred from different medical specialities and assessed AF detection rates by indication, age and comorbidities.

Results Seven-day Holter ECGs (median monitoring 127.5 hours, IQR 116 to 152) were recorded in 476 patients (mean age 54.6 (SD 17.0) years, 55.9% female) without previously known AF, requested to evaluate palpitations (n=241), syncope (n=99), stroke or transient ischaemic attack (n=75), dizziness (n=29) or episodic chest pain (n=32). AF was newly detected in 42/476 (8.8%) patients. Oral anticoagulation was initiated in 40/42 (95.2%) patients with newly detected AF. Multivariate logistic regression, adjusted for age, sex and monitoring duration found four clinical parameters to be associated with newly detected AF: hypertension OR=2.54, (1.08 to 8.61) (adjusted OR (95% CI)), p=0.034; previous stroke or TIA OR=4.14 (1.81 to 13.01), p=0.001; left-sided valvular heart disease OR=5.07 (2.48 to 18.70), p<0.001 and palpitations OR=2.86, (1.33 to 10.44), p=0.015.

Conclusions Open multispeciality access to prolonged ECG monitoring, for example, as part of integrated, cross-sector AF care, can accelerate diagnosis of AF and increase adequate use of oral anticoagulation, especially in older and symptomatic patients with comorbidities.

  • atrial fibrillation
  • stroke
  • Holter ECG
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/openhrt-2019-001151

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    Footnotes

    • Presented at The work for this paper was performed at the Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, UK and the Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.

    • Funding This study was supported by the clinical effectiveness programme of SWBH NHS trust. Further support came from European Union (grant agreement 633196 (CATCH ME) and by British Heart Foundation (AA/18/2/34218). PK has received research support from EU, BHF, Leducq Foundation, Medical Research Council (UK) and German Centre for Cardiovascular Research, from several drug and device companies active in AF, and has received honoraria from several such companies.

    • Competing interests PK and LF are listed as inventors on two patents held by University of Birmingham (WO 2015140571, WO 2016012783). RD and AM have received honoraria for delivering educational lectures from manufacturers of anticoagulant medications.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request subject to permission from organisation.