Diagnostic yield of a portable electrocardiographic device versus 24-hours conventional holter monitoring in the diagnosis of arrhythmic events
Authors: Torres Gonzalez N , Alvarez-Acosta L , Valdivia-Miranda D , Barreto-Caceres V , Iriarte-Plasencia A , Cappellesso P , Ramos Reyes V , Hernandez Castellano S , Quijada Fumero A , Lorenzo Gonzalez A , Hernandez-Afonso JS 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The study of palpitations, presyncope or dizziness constitutes an important part of the cardiology consultations. These symptoms are nonspecific most of times, and with the usual diagnostic tools (24-hour Holter mainly) it is difficult to reach an accurate diagnosis, since episodes occur erratically once or a few times a month. The Kardia® electrocardiographic monitoring device is a diagnostic tool that allows the patient to self-perform ECG based on symptoms and send it for later review and interpretation by a cardiologist.

Purpose
We compared the diagnostic yield of the conventional 24-hour Holter monitor versus the Kardia® device in patients undergoing a cardiology study.

Methods
We conducted a prospective cohort study in 36 patients referred to the cardiology consultation due to palpitations or presyncope. In all of them, a 24-hour Holter was carried out, according to the usual protocol, and then a KardiaMobile® 6L device was given for a month. They received training to perform an ECG (six limb leads) and use the mobile application. The quantitative variables are expressed as means and standard deviation and the qualitative values as percentages.

Results
The study included 36 patients, of which 66.7% were women and 33.3% men, mean age of 44.2±14.3 years. The most frequent clinical symptom was palpitations (88.9%). Regarding the 24-hour Holter, only 22.2% of patients felt the symptoms for which they consulted during the day they wore it. Only in 19.4% the etiological diagnosis was reached through this method. Regarding the KardiaMobile® device, 72.2% of patients presented symptoms during the month of follow-up. Through the records obtained with this device, the diagnosis was reached in 52.8% of the cases, taking into account that if the patient reported having symptoms at the time the ECG was performed, if the ECG was normal, it was considered a diagnostic success, since the non-cardiological cause of the symptom was demonstrated. The diagnosis implied a therapeutic approach in 30.6% of cases: antiarrhythmic drugs were started in 8 patients, and 4 electrophysiological studies were indicated: in 3 patients for AVRNT ablation and in 1 patient for sustained ventricular tachycardias. Table1 shows a summary of the results.

Conclusion
Despite the limited number of patients, in our study, the 30-day recording with portable KardiaMobile® monitoring system showed statistically significant superiority (p &lt;0.05) compared to the conventional 24-hour Holter monitor in the etiological diagnosis of palpitations and dizziness in a selected group of patients.
It must be borne in mind that this is a relatively young population and the study needs to be extended to a larger number of patients to generalize these conclusions. The main limitation of the KardiaMobile® device is that it requires minimal skills in terms of using a smartphone, so this tool is not extensible to any patient profile.