For years we have used ambulatory Holter monitoring to try and detect symptomatic arrhythmias in patients. However, many of these tests are ineffective when patient symptoms are less frequent than daily or even weekly. We have looked at a subgroup of patients suffering from infrequent palpitations and offered them a Kardia device for a 25-day monitoring period.
The Kardia mobile device was identified by the NHS Innovation Accelerator in 2015 as a monitor available for detecting atrial fibrillation in the community. However, the scope of this monitor is much greater than atrial fibrillation screening. We have found it can detect not only atrial fibrillation, but any symptomatic arrhythmia including atrial or ventricular ectopy, supraventricular and ventricular tachycardias.
The clinic was set up at Wycombe Hospital with referrals restricted to Consultant Cardiologists and Cardiac Specialist Nurses who felt their patients met the inclusion criteria. The patient selection involved those with infrequent palpitations who were smart-phone literate. Patients were asked to send tracings of a single-channel ECG using a Kardia device during their episodes of palpitations. Their tracing could then be sent from their smartphone to a secure NHS email address for review by a Cardiac Physiologist. Results from the Kardia clinic would be reported to the referrer and patients had appropriate follow-up.
We have now been able to prove there is a diagnostic place for outpatient mobile monitoring with the success of our Kardia clinic that has been running since December 2017; a one-sample proportion test proved there was >50% likelihood of a symptom–rhythm correlation (p=0.000, 76% of patients) and >50% likelihood of diagnosing an arrhythmia or sinus tachycardia (p=0.006, 62% of patients). These results are of great value to the future management of infrequent palpitations on an outpatient basis for the specialty of cardiology.
