Work

Relationship of symptom frequency and symptom-rhythm correlation to arrhythmia type and time to detection: Insights from ambulatory electrocardiogram monitoring in over 1 million patients

Year: 2025

Type: article

Abstract: BACKGROUND: Arrhythmias are challenging to detect owing to their intermittent nature and variability in symptom reporting. Although long-term continuous monitoring (≤14 days) yields more diagnoses than short-term (Holter) monitoring (≤48 hours), Holter is often preferred by clinicians and payors for frequent symptoms despite limited evidence linking symptom frequency to optimal monitoring duration. OBJECTIVE: This study aimed to assess the relationship between symptom frequency and arrhythmia detection in long-term continuous monitoring patients. METHODS: We performed a retrospective cohort study of adults aged ≥18 years with uninterrupted, patch-based long-term continuous monitoring (≤14 days) with push-button symptom annotation between June 2023 and July 2024. Symptom frequency was defined by device button presses: daily (≥1/d) or nondaily (<1/d). Outcomes included arrhythmia yield, time to first arrhythmia, and symptom-rhythm correlation. RESULTS: Among 1,100,337 devices, 20.8% of patients had daily symptoms and the actionable arrhythmia yield was 35.8%. Most arrhythmias occurred after 48 hours (daily 64.0%; nondaily 59.9%). The median time to detection was >48 hours for daily (3.52 days [Q1-Q3 0.94-7.45]) and nondaily symptoms (3.00 [0.72-6.97]). Adjusted odds of arrhythmia yield did not differ by symptom frequency (adjusted odds ratio 1.00; 95% confidence interval 0.98-1.02). Symptom-rhythm correlation was 18.3% overall and highest for atrial fibrillation and isolated ectopic beats (>30%), but <15% for other rhythms. Patients with nondaily symptoms had lower odds of symptom-rhythm correlation (adjusted odds ratio 0.226; 95% confidence interval 0.223-0.229). CONCLUSION: Symptom-rhythm correlation varied by arrhythmia type and symptom frequency. The median time to actionable arrhythmia was >48 hours, regardless of symptom frequency. Holter may miss clinically meaningful events, even in patients with daily symptoms.

Source: Heart Rhythm

DOI: 10.1016/j.hrthm.2025.11.007