Abstract 13416: The Days of the Holter Monitor Are Numbered: Extended Continuous Rhythm Monitoring Detects More Clinically Significant Arrhythmias in Adults With Congenital Heart Disease
Introduction: Arrhythmias are a leading cause of death in adults with congenital heart disease (ACHD). Arrhythmia detection is essential to management and risk assessment in ACHD. While 24 to 48-hour Holter monitors are often used to assess arrhythmia burden, extended continuous rhythm monitors (ECRM) can record 2 weeks of data. We hypothesized that more clinically significant arrhythmias would be detected on ECRM beyond the first 48 hrs of monitoring.
Methods: We reviewed ambulatory Zio® (iRhythm, San Francisco, CA) monitors performed in ACHD patients from June 2013 - May 2016. Atrial fibrillation/flutter (AF), ventricular tachycardia (VT), supraventricular tachycardia (SVT), sinus pause >3 sec, and 3rd or 2nd degree type II atrioventricular block (AVB) were considered significant. Number and type of arrhythmias detected within the first 48 hrs were compared to those identified beyond 48 hrs.
Results: A total of 387 monitors were performed in 306 patients (34 ± 12.5 yrs, 40% male). The most common diagnoses were Tetralogy of Fallot, transposition of the great arteries, and single ventricle after Fontan. Average wear time was 9.4 ± 4.2 d. Overall, 51% of ECRM showed a significant arrhythmia, fewer than half of which were noted during the first 48 hrs (25% overall). VT was detected by ECRM in 17%, only 30% of which were within 48 hrs. SVT was detected by ECRM in 40%, 48% of which were within 48 hrs. Kaplan-Meier estimates of freedom from arrhythmia are shown in the table and figure.
Conclusion: ECRM was more likely to detect a significant arrhythmia beyond the standard 48-hour monitoring period in ACHD patients, suggesting that ECRM may be more useful than Holter monitoring in this population.
- Adult congenital heart disease
- Atrial arrhythmias
- Ventricular arrhythmia
- Disease management
- Congenital heart disease
Author Disclosures: K. Schultz: None. G. Lui: None. D. McElhinney: None. S. Fernandes: None. A. Dubin: None. I. Rogers: None. M. Viswanathan: None. A. Romfh: None. K. Motonaga: None. S. Ceresnak: None.
- © 2016 by American Heart Association, Inc.