Patch versus traditional ambulatory ECG monitoring in children

Background: Patch ambulatory electrocardiogram (ECG) monitors may provide an advantage over traditional wired ambulatory ECG devices, such as Holter and event monitors, but there is limited data comparing their clinical impact in the pediatric population. Objective: This study sought to directly compare traditional wired ambulatory ECG devices to a patch ambulatory monitor in terms of clinical impact and ability to detect significant arrhythmias. Methods: This retrospective cohort study included outpatients 0–18 years old who received ambulatory ECG monitoring at our institution. A cohort consisting of all patients evaluated with a Holter or event monitor between 5/2011–2/2013 (prior to patch ECG use) was compared with a time-matched cohort from 2015 to 2017 when patch monitors (Zio) were the sole ambulatory ECG devices used in our practice. Chart review was conducted to determine the clinical impact of all monitor results. Results: Cardiologists prescribed patch monitors more frequently than traditional monitors (1 per 11.5 vs 21.8 clinical encounters, p < 0.0001). The primary indication for monitoring differed, with patch monitors being used more often for patient-reported symptoms including palpitations, pre-syncope, or syncope (38.6% vs 23.8%, p < 0.01). Detection rates of serious arrhythmias were similar, when assessing results that led to new intervention (6.2% versus 7.7%, p = 0.55) or increased clinical surveillance (5.0% vs 4.2%, p = 0.82). Yet, patch monitoring more frequently yielded results that allowed patients to be discharged from cardiology follow-up (46.8% vs 36.8%, p = 0.01). Conclusions: In terms of diagnosing serious arrhythmias that escalated clinical management, patch ambulatory ECG monitors provided similar clinical impact as traditional monitors, but they more often provided results that allowed discharge from cardiology care.