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

Authors' objectives: MAIN OBJECTIVE: 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 cardiac arrhythmias. SECONDARY OBJECTIVE: To identify alternative ambulatory devices to Holter monitoring for the recording of electrocardiographic signals.

Authors' results and conclusions: RESULTS: Sixty nine of 1120 references identified were selected for their complete review. Finally, 11 articles were included in the review: one systematic review and 10 articles related to 9 diagnostic studies. The aim of the included systematic review was to assess the safety, effectiveness and cost-effectiveness of the implanted loop recorder for patients with unexplained syncope after several tests, ECG and/or Holter monitoring, who were suspected of having arrhythmia or unexplained recurrent syncope. The author’s conclusion was that the use of the implanted loop recorder yields a grater number of patients with diagnosis in comparison to conventional monitoring. Despite this, the authors did not find studies that allow measure the diagnostic accuracy. Nine diagnostic studies were included: one of them compared Holter and event recorder, other study compared implantable cardioverter defibrillator and Holter and the rest of studies compared pacemaker and Holter. All of them assessed supraventricular arrhythmias. The studies had different but good valuation of quality in general according to QUADAS tool. The results of included studies can be summarized as follows: 1. Five of 7 studies that compared pacemaker and Holter reported sensitivity and specificity values over 90%, the other two studies had little sample sizes, less than 20 patients. 2. The study that compared implantable cardioverter defibrillator and Holter reported sensitivity and specificity values near 100%. 3. The only study that compared event recorder and Holter did not detect any clinically significant arrhythmia so sensitivity could not be measured; the specificity of event recorder was 81,4% according to our estimation. CONCLUSIONS: • The diagnostic accuracy (sensitivity and specificity) of pacemaker for diagnosis and monitoring of supraventricular arrhythmias is good. This is based in several diagnostic studies of acceptable quality. • The diagnostic accuracy of the implantable cardioverter defibrillator is good although this is based in one diagnostic study of acceptable quality that could have some bias. • The specificity of the event recorder is relatively high although this is based in one study whose main aim was not to assess the diagnostic accuracy of this device in comparison to Holter as reference standard. • There are AECG devices for diagnosis and monitoring of arrhythmias in the market that are used in the clinic practice whose diagnostic accuracy have not been assessed or published properly.

Authors' methods: A 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 OVID-Medline, The Cochrane Library Plus, EMBASE, CINAHL, NHS CRD, IME and others. The search strategy was developed with help of experts and a filter for diagnostic studies was used. The search was limited to published studies between 1996 January and 2006 July, in English or Spanish language. References lists of selected articles and webs of health technology assessment agencies 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, syncope, cardiac block, palpitations and others). 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 the systematic review was assessed using the Centre for Reviews and Dissemination criteria (University of York); the quality of diagnostic studies was assessed using the QUADAS tool. The NICE level of evidence was used to classify studies. The data collected were synthesized through narrative procedures with detailed tables of the results.

Project Status: Completed

Year Published: 2007

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

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