Article Text
Abstract
Objectives Recent technology advances have allowed for heart rhythm monitoring using single-lead ECG monitoring devices, which can be used for early diagnosis of atrial fibrillation (AF). We sought to investigate the AF detection rate using portable ECG devices compared with Holter monitoring.
Setting, participants and outcome measures We searched the Medline, Embase and Scopus databases (conducted on 8 May 2017) using search terms related to AF screening and included studies with adults aged >18 years using portable ECG devices or Holter monitoring for AF detection. We excluded studies using implantable loop recorders and pacemakers. Using a random-effects model we calculated the overall AF detection rate. Meta-regression analysis was performed to explore potential sources for heterogeneity. Quality of reporting was assessed using the tool developed by Downs and Black.
Results Portable ECG monitoring was used in 18 studies (n=117 436) and Holter monitoring was used in 36 studies (n=8498). The AF detection rate using portable ECG monitoring was 1.7% (95% CI 1.4 to 2.1), with significant heterogeneity between studies (p<0.001). There was a moderate linear relationship between total monitoring time and AF detection rate (r=0.65, p=0.003), and meta-regression identified total monitoring time (p=0.005) and body mass index (p=0.01) as potential contributors to heterogeneity. The detection rate (4.8%, 95% CI 3.6% to 6.0%) in eight studies (n=10 199), which performed multiple ECG recordings was comparable to that with 24 hours Holter (4.6%, 95% CI 3.5% to 5.7%). Intermittent recordings for 19 min total produced similar AF detection to 24 hours Holter monitoring.
Conclusion Portable ECG devices may offer an efficient screening option for AF compared with 24 hours Holter monitoring.
PROSPERO registration number CRD42017061021.
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Footnotes
Contributors SR performed the literature search and analysis of individual studies. Involved in the statistical analysis, manuscript preparation and editing. THM is guarantor. Developed project idea/rationale. Involved in data analysis and manuscript preparation and editing. NN was involved in data and statistical analysis as well as manuscript preparation and editing. DDS performed the literature search and analysis of individual studies. Involved in the manuscript preparation and editing. DJP was involved in analysis of individual studies and statistical analysis. Involved in manuscript preparation and editing. JMK was involved in the project outline, data analysis, manuscript preparation and editing.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer The sponsors had no role in the design and conduct of the study, in the collection, analysis and interpretation of the data and in the preparation, review or approval of the manuscript.
Competing interests SR receives equipment and software support from Semacare, a manufacturer of handheld ECG devices. Receives research scholarships from the Heart Foundation and Avant. THM receives equipment and software support from Semacare.
Patient consent Not requried.
Ethics approval Tasmanian Health and Medical Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement There are no remaining unpublished data.