title: Reliability and limitations of automated arrhythmia detection in telemetric monitoring after stroke.
abstract: OBJECTIVE
  Guidelines recommend continuous ECG monitoring in patients with cerebrovascular events. Studies on intensive care units (ICU) demonstrated high sensitivity but high rates of false alarms of monitoring systems resulting in desensitization of medical personnel potentially endangering patient safety. Data on patients with acute stroke are lacking.
  
  
  METHODS
  One-hundred fifty-one consecutive patients with acute cerebrovascular events were prospectively included. Automatically identified arrhythmia events were analyzed by manual ECG analysis. Muting of alarms was registered. Sensitivity was evaluated by beat-to-beat analysis of the entire recorded ECG data in a subset of patients. Ethics approval was obtained by University of Erlangen-Nuremberg.
  
  
  RESULTS
  A total of 4809.5 hours of ECG registration and 22 509 alarms were analyzed. The automated detection algorithm missed no events but the overall rate of false alarms was 27.4%. Only 0.6% of all alarms indicated acute life-threatening events and 91.4% of these alarms were incorrect. Transient muting of acoustic alarms was observed in 20.5% patients.
  
  
  CONCLUSIONS
  Continuous ECG monitoring using automated arrhythmia detection is highly sensitive in acute stroke. However, high rates of false alarms and alarms without direct therapeutic consequence cause desensitization of personnel. Therefore, acoustic alarms may be limited to life-threatening events but standardized manual evaluation of all alarms should complement automated systems to identify clinically relevant arrhythmias.
authors.affiliation: From the Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (N.K., T.B., B.K., J.K., S.S., M.K.) and Neurologische Klinik, Johannes Wesling Klinikum, Minden, Germany (P.D.S.). natalia.kurka@uk-erlangen.de.
authors.forename: Natalia
authors.initials: N
authors.lastname: Kurka
authors.affiliation: From the Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (N.K., T.B., B.K., J.K., S.S., M.K.) and Neurologische Klinik, Johannes Wesling Klinikum, Minden, Germany (P.D.S.).
authors.forename: Tobias
authors.initials: T
authors.lastname: Bobinger
authors.affiliation: From the Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (N.K., T.B., B.K., J.K., S.S., M.K.) and Neurologische Klinik, Johannes Wesling Klinikum, Minden, Germany (P.D.S.).
authors.forename: Bernd
authors.initials: B
authors.lastname: Kallmünzer
authors.affiliation: From the Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (N.K., T.B., B.K., J.K., S.S., M.K.) and Neurologische Klinik, Johannes Wesling Klinikum, Minden, Germany (P.D.S.).
authors.forename: Julia
authors.initials: J
authors.lastname: Koehn
authors.affiliation: From the Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (N.K., T.B., B.K., J.K., S.S., M.K.) and Neurologische Klinik, Johannes Wesling Klinikum, Minden, Germany (P.D.S.).
authors.forename: Peter D
authors.initials: PD
authors.lastname: Schellinger
authors.affiliation: From the Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (N.K., T.B., B.K., J.K., S.S., M.K.) and Neurologische Klinik, Johannes Wesling Klinikum, Minden, Germany (P.D.S.).
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.affiliation: From the Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (N.K., T.B., B.K., J.K., S.S., M.K.) and Neurologische Klinik, Johannes Wesling Klinikum, Minden, Germany (P.D.S.).
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology*; D004562:Electrocardiography / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology*; D013686:Telemetry / Q000592:standards*
keywords: arrhythmia; electrocardiography; monitoring; stroke