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Can 24 h of ambulatory ECG be used to triage patients to extended monitoring?
Johnson, Linda S; Måneheim, Alexandra; Slusarczyk, Magdalena; Grotek, Agnieszka; Witkowska, Olga; Bacevicius, Justinas; Sörnmo, Leif; Dziubinski, Marek; Bhavnani, Sanjeev; Healey, Jeffrey S; Engström, Gunnar.
Afiliação
  • Johnson LS; Department of Clinical Sciences, Lund University, Lund, Sweden.
  • Måneheim A; MEDICALgorithmics, Warsaw, Poland.
  • Slusarczyk M; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
  • Grotek A; Department of Clinical Sciences, Lund University, Lund, Sweden.
  • Witkowska O; Department of Clinical Physiology, Skåne University Hospital, Malmö, Sweden.
  • Bacevicius J; MEDICALgorithmics, Warsaw, Poland.
  • Sörnmo L; MEDICALgorithmics, Warsaw, Poland.
  • Dziubinski M; MEDICALgorithmics, Warsaw, Poland.
  • Bhavnani S; Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
  • Healey JS; Department of Biomedical Engineering, Lund University, Lund, Sweden.
  • Engström G; MEDICALgorithmics, Warsaw, Poland.
Ann Noninvasive Electrocardiol ; 28(6): e13090, 2023 11.
Article em En | MEDLINE | ID: mdl-37803819
ABSTRACT

BACKGROUND:

Access to long-term ambulatory recording to detect atrial fibrillation (AF) is limited for economical and practical reasons. We aimed to determine whether 24 h ECG (24hECG) data can predict AF detection on extended cardiac monitoring.

METHODS:

We included all US patients from 2020, aged 17-100 years, who were monitored for 2-30 days using the PocketECG device (MEDICALgorithmics), without AF ≥30 s on the first day (n = 18,220, mean age 64.4 years, 42.4% male). The population was randomly split into equal training and testing datasets. A Lasso model was used to predict AF episodes ≥30 s occurring on days 2-30.

RESULTS:

The final model included maximum heart rate, number of premature atrial complexes (PACs), fastest rate during PAC couplets and triplets, fastest rate during premature ventricular couplets and number of ventricular tachycardia runs ≥4 beats, and had good discrimination (ROC statistic 0.7497, 95% CI 0.7336-0.7659) in the testing dataset. Inclusion of age and sex did not improve discrimination. A model based only on age and sex had substantially poorer discrimination, ROC statistic 0.6542 (95% CI 0.6364-0.6720). The prevalence of observed AF in the testing dataset increased by quintile of predicted risk 0.4% in Q1, 2.7% in Q2, 6.2% in Q3, 11.4% in Q4, and 15.9% in Q5. In Q1, the negative predictive value for AF was 99.6%.

CONCLUSION:

By using 24hECG data, long-term monitoring for AF can safely be avoided in 20% of an unselected patient population whereas an overall risk of 9% in the remaining 80% of the population warrants repeated or extended monitoring.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Complexos Atriais Prematuros Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Complexos Atriais Prematuros Idioma: En Ano de publicação: 2023 Tipo de documento: Article