Original Title: Sistemas alternativos al Holter convencional para el estudio de las arritmias cardiacas de forma ambulatoria (actualización)

Authors' objectives: To know the validity of alternative systems to Holter monitoring to store and help the interpretation of electrocardiographic signals in an ambulatory way for the diagnosis and monitoring of some specific cardiac arrhythmias.

Authors' results and conclusions: RESULTS: The electronic search identified 869 references, 123 were selected for their complete review. Finally, 9 articles were included in the review that, in addition to the references included in the previous review, result in 19 papers related to 18 diagnostic studies: 9 studies assessed AECG devices for diagnosis of arrhythmias and 9 studies assessed the diagnostic function of therapeutic devices like pacemaker or implantable cardioverter defibrillator. The results of the included studies can be summarized as follows: • The event recorder was studied in 5 papers. The sensitivity of the event recorder in comparison to Holter in patients with AF is high. Based on one study of acceptable methodological quality, without disease progression bias, the specificity of the event recorder is high. • Only one paper studied the event recorder for AF in patients who had suffered an ischaemic stroke or a transient ischaemic attack. Disease progression bias could occur in this study so the estimated indicators must be interpreted carefully. • The ICM was studied in 3 studies. The sensitivity of the ICM in comparison to Holter in patients with AF is very high, while the specificity is variable depending on the study analysed. Based on the study with the best methodological quality the estimated specificity is high. • Only one paper studied the continuous recorder. Disease progression bias could occur in this study so the estimated indicators must be interpreted carefully. • The diagnostic validity of the pacemaker in terms of sensitivity and specificity for the diagnosis and monitoring of supraventricular arrhythmias is generally good. This is based on several studies of diagnostic tests of acceptable quality. However, the most recent study estimated poor indicators. • A single study compared the implantable cardioverter defibrillator with conventional Holter reporting sensitivity and specificity of the defibrillator very close to 100%. However, disease progression bias could occur in this study. The objective of some of the studies was not to assess the sensibility and specificity of the device versus conventional Holter as the reference standard. Consequently, the interpretation of the estimations made for this review must be prudent. Also, this review did not focus in all diagnostic tests for any kind of arrhythmia, so it is not possible to conclude what device is the best one for the diagnosis of those arrhythmias whose gold standard is not the Holter.

Authors' recommendations: Based on the results of this systematic review, the following recommendations are made: • There is no enough evidence to recommend or not recommend the use of the event recorder or the continuous recorder in the study of AF or in patients who had suffered an ischaemic stroke / transient ischaemic attack. • The ICM could be a technology reimbursed when it is used for the diagnosis and monitoring of patients with paroxismal AF in selected cases when the symptoms are infrequent and other less invasive diagnostic procedures were used previously. • To not disregard the use of Holter for the diagnosis and monitoring of arrhythmias in patients with pacemakers or implantable cardioverter defibrillator when it is not demonstrated the validity of every device. • To request high methodological quality studies for every new diagnostic or monitoring device as a necessary condition to be included in the list of reimbursed technologies in our National Health System.

Authors' methods: An update of a previous systematic review of diagnostic accuracy of those alternative AECG devices to Holter test for diagnosis and monitoring of arrhythmias was carried out. Systematic searches were made in electronic databases MEDLINE and MEDLINE in process, The Cochrane Library Plus, EMBASE, CINAHL, CRD (DARE, HTA, NHS-EED) in January 2013. The search strategy was developed with help of experts and a filter for diagnostic studies was used. The search was limited to published studies from 2006 (date of previous review) to present, in English or Spanish language. References lists of selected articles were reviewed. Those articles of diagnostic studies in which Holter monitoring was compared to other AECG device were selected. The design of studies should allow the estimation of diagnostic accuracy, sensitivity and specificity. Participants should be adults over 18 years old with arrhythmias or suspect of arrhythmias (bradycardia, tachycardia, atrial fibrillation (AF), etc.), heart blocks, sudden cardiac death, or symptoms like syncope or palpitations. The studies were selected independently by two reviewers. The data extraction from the included studies was carried out by a reviewer and checked by a second reviewer. The data were gathered in spreadsheets designed ad hoc. The methodological quality was independently reviewed by two reviewers. Where the reviewers disagreed, they would negotiate. When consensus was not reached, a third reviewer was consulted. The quality of diagnostic studies was assessed using the QUADAS tool. The data collected were synthesized through narrative procedures with detailed tables of the results.

Project Status: Completed

Year Published: 2013

URL for published report: https://sescs.es/sistemas-alternativos-al-holter-para-el-estudio-de-las-arritmias-cardiacas-de-forma-ambulatoria/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es