title: Wireless monitoring of reconstructed 12-lead ECG in atrial fibrillation patients enables differential diagnosis of recurrent arrhythmias.
abstract: Differential diagnosis of symptomatic events in post-ablation atrial fibrillation (AF) patients (pts) is important; in particular, accurate, reliable detection of AF or atrial flutter (AFL) is essential. However, existing remote monitoring devices usually require attached leads and are not suitable for prolonged monitoring; moreover, most do not provide sufficient information to assess atrial activity, since they generally monitor only 1-3 ECG leads and rely on RR interval variability for AF diagnosis. A new hand-held, wireless, symptom-activated event monitor (CardioBip; CB) does not require attached leads and hence can be conveniently used for extended periods. Moreover, CB provides data that enables remote reconstruction of full 12-lead ECG data including atrial signal information. We hypothesized that these CB features would enable accurate remote differential diagnosis of symptomatic arrhythmias in post-ablation AF pts.
  
  
  METHODS
  21 pts who underwent catheter ablation for AF were instructed to make a CB transmission (TX) whenever palpitations, lightheadedness, or similar symptoms occurred, and at multiple times daily when asymptomatic, during a 60 day post-ablation time period. CB transmissions (TXs) were analyzed blindly by 2 expert readers, with differences adjudicated by consensus.
  
  
  RESULTS
  7 pts had no symptomatic episodes during the monitoring period. 14 of 21 pts had symptomatic events and made a total of 1699 TX, 164 of which were during symptoms. TX quality was acceptable for rhythm diagnosis and atrial activity in 96%. 118 TX from 10 symptomatic pts showed AF (96 TX from 10 pts) or AFL (22 TX from 3 pts), and 46 TX from 9 pts showed frequent PACs or PVCs. No other arrhythmias were detected. Five pts made symptomatic TX during AF/AFL and also during PACs/PVCs.
  
  
  CONCLUSIONS
  Use of CB during symptomatic episodes enabled detection and differential diagnosis of symptomatic arrhythmias. The ability of CB to provide accurate reconstruction of 12 L ECGs including atrial activity, combined with its ease of use, makes it suitable for long-term surveillance for recurrent AF in post-ablation patients.
authors.affiliation: Dedinje Cardiovascular Inst, Belgrade, Serbia.
authors.forename: Dejan
authors.initials: D
authors.lastname: Vukajlovic
authors.forename: Ihor
authors.initials: I
authors.lastname: Gussak
authors.forename: Samuel
authors.initials: S
authors.lastname: George
authors.forename: Goran
authors.initials: G
authors.lastname: Simic
authors.forename: Bosko
authors.initials: B
authors.lastname: Bojovic
authors.forename: Ljupco
authors.initials: L
authors.lastname: Hadzievski
authors.forename: Bojan
authors.initials: B
authors.lastname: Stojanovic
authors.forename: Lazar
authors.initials: L
authors.lastname: Angelkov
authors.forename: Dorin
authors.initials: D
authors.lastname: Panescu
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis*; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000295:instrumentation*; D006801:Humans; D008875:Middle Aged; D011846:Radio Waves