title: Early Detection of Symptomatic Paroxysmal Cardiac Arrhythmias by Trans-Telephonic ECG Monitoring: Impact on Diagnosis and Treatment of Atrial Fibrillation.
abstract: Diagnosis of infrequent cardiac arrhythmias (CA) is often unsuccessful using resting or Holter ECG. As early detection and treatment of CA, especially atrial fibrillation (AF), has implications on patients' treatment and outcome, we investigated, whether self-guided, trans-telephonic event-recorder monitoring (Tele-ECG) improves diagnosis and influences treatment options.
  
  
  
  Between 2009 and 2014, 790 patients (54 ± 18 years, 40% male; no history of CA: 582, known AF: 179, other CA: 29) presented with recurrent symptoms suggestive of CA and were screened by Tele-ECG (17.3 ± 26.9 days). A total of 11,775 ECGs were transmitted via a 24-hour telephone hotline including documentation of the respective symptoms.
  
  
  
  In 73% of patients, CA was documented at the time of symptoms: sinus tachycardia 23%, premature ventricular beats 19%, AF 14%, supraventricular tachycardia 9%, sinus bradycardia 5%, sinus arrhythmia 2%, and AV block II 1%. The mean time until the first symptomatic episode occurred was 6.9 ± 15.3 days (median 2.5 days). The first documented arrhythmia occurred on average after 7.7 ± 14.1 days (median 3 days). In patients with AF (n = 110), 44% was newly diagnosed. According to the Tele-ECG diagnosis, AF ablation was performed in 27% of these patients, 7% electrical cardioversion, and in 30% antiarrhythmic therapy was initiated. In 65% of the patients with recurrence of known AF, (re-)ablation was performed or recommended and in 16% antiarrhythmic therapy was modified.
  
  
  
  Tele-ECG monitoring is effective in the diagnosis of suspected symptomatic CA. A diagnosis can usually be achieved within 1 week and has implications on patients' care.
authors.affiliation: Department of Clinical and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Anczykowski
authors.affiliation: Department of Cardiology - Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.affiliation: Department of Cardiology - Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Boris A
authors.initials: BA
authors.lastname: Hoffmann
authors.affiliation: Department of Clinical and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
authors.affiliation: Department of Clinical and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: Department of Clinical and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany. patten@uke.de.
authors.forename: Monica
authors.initials: M
authors.lastname: Patten
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation; D042241:Early Diagnosis; D004554:Electric Countershock; D004562:Electrocardiography / Q000295:instrumentation*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D015277:Hotlines; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012086:Reoperation; D017216:Telemedicine / Q000295:instrumentation*; D013686:Telemetry / Q000295:instrumentation*; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: ambulatory ECG monitoring; atrial fibrillation; cardiac arrhythmias; catheter ablation; event recorder monitoring; palpitations; telemedicine