Methods for Ambulatory Arrhythmia Monitoring A Comparison Study of Holter Monitor and Chest Strap ECG A Prospective Pilot Study

Background Cardiac arrhythmias, including atrial fibrillation (AF), are a common cause for seeking medical care. AF has many causes; where valvular disease, hypertension, heart failure and diabetes mellitus are among the most common ones. The golden standard for arrhythmia monitoring is a 24or 48-hours Holter monitor. The aim with this paper was to compare the Holter monitor with chest strap ECG, regarding the sensitivity to detect atrial fibrillation, and the amount of noise and artifacts. Patients and methods Five patients were included in the study. Patients fulfilled the inclusion criteria if they were >18 years old and scheduled for rhythm monitoring in order to detect atrial fibrillation. Patients with a history of mental illness were excluded. A total of 123 hours and 20 minutes were registered simultaneously with each monitor type. A Holter (DigiTrak XT) from Philips (Amsterdam, The Netherlands). monitor was used, and the chest strap ECG (Linkura AB, Linköping, Sweden) is made of a small device, which is snapped on the chest strap belt (Polar, Finland). Results Patient number five had atrial fibrillation during the whole monitoring time according to both the Holter and chest strap ECG. The chest strap ECG recorded a greater number of episodes of noise and artifacts/hour (median 97.0) compared to the Holter monitor (median 7.3), p = 0.07. The chest strap ECG monitoring resulted in 0-13.9 % (median 2.7) of noise and artifacts of total amount of time, compared to the Holter monitor (0-0.6 % , median 0.2), p = 0.07. Patient number three was an outlier with 503 episodes/hour and 13.9% noise and artifacts of total amount of time, on the chest strap ECG registration. Conclusion In conclusion, the chest strap ECG can be used to detect atrial fibrillation on the basis of pwave detection, although it needs to be tested more, and with an automatic algorithm, which allows an analysis of a larger study population. The chest strap ECG recorded a greater number of episodes of noises and artifacts compared to the Holter. This did not reach a statistical significance, but can be clinically relevant.