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According to study results presented Thursday at the Heart Rhythm Society's (HRS) annual meeting, human oversight-dependent continuous electrocardiography (ECG) monitoring was more than 200% more effective at detecting critical arrhythmias than algorithm-dependent mobile cardiac telemetry (MCT). "Because every cardiac monitor employs different reporting methods to process recorded rhythms, it can be challenging for physicians…interpreting the final report," remarked lead author Mark Willcox, but the new findings suggest that pairing technology with key human oversight and input, proved to be the most accurate.
Researchers recruited 50 sequential patients from an outpatient arrhythmia clinic. Of those, 46 successfully wore both Preventice Solutions' BodyGuardian MCT and Bardy Diagnostics' Carnation long-term continuous ECG monitor simultaneously for periods ranging from 1.2 days to 14.8 days. The study reports were reviewed by two electrophysiologists and categorised based on whether significant clinical arrhythmias were identified and correctly diagnosed.
During the simultaneous recording, MCT diagnosed significant arrhythmias in 11 patients overall, whereas long-term continuous ECG monitoring did so in 23 of the patients, representing a 209% increase. Researchers noted that the ECG monitoring diagnosed two cases of AV node re-entrant tachycardia and three cases of second-degree AV block that were not flagged by MCT. The ECG also diagnosed ventricular tachycardia in 13 patients, compared with seven for MCT. Further, while atrial fibrillation (AF) was reported by both monitors in two patients, long-term continuous ECG captured four additional episodes of AF that had been missed by MCT.
The authors noted some limitations of the study, including its small size, with only two monitors compared, adding that manufacturers' processes can change.
At the HRS2021 press briefing, Willcox commented that the data highlighted that "not all monitors are created equal," adding that "we all know from reading ECGs that computers aren't quite as good as human beings, yet we rely on them a lot in the outpatient world." While Willcox noted that artificial intelligence is getting better, he added that "clinicians need to recognise that we're not there yet." He also said that the study results would impact his clinical decision-making process, as now he has to consider differences in arrhythmia detection and duration, while he previously assumed arrhythmia detection was similar.
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