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Using a novel wireless system for monitoring patients after the atrial fibrillation ablation procedure: The iTransmit study

  • Khaldoun G. Tarakji
    Correspondence
    Address reprint requests and correspondence: Dr Khaldoun G. Tarakji, Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue / J2-2, Cleveland, OH 44195
    Affiliations
    Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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  • Oussama M. Wazni
    Affiliations
    Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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  • Thomas Callahan
    Affiliations
    Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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  • Mohamed Kanj
    Affiliations
    Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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  • Ali H. Hakim
    Affiliations
    Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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  • Kathy Wolski
    Affiliations
    Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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  • Bruce L. Wilkoff
    Affiliations
    Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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  • Walid Saliba
    Affiliations
    Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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  • Bruce D. Lindsay
    Affiliations
    Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Published:November 18, 2014DOI:https://doi.org/10.1016/j.hrthm.2014.11.015

      Background

      A novel technology incorporates electrodes into an iPhone case that records an electrocardiographic tracing.

      Objectives

      The objectives of this study were to examine the feasibility and efficacy of this technology to monitor patients after the atrial fibrillation (AF) ablation procedure and to assess patients’ feedback on its ease of use.

      Methods

      Patients with AF undergoing ablation who had iPhones were screened for enrollment. They were provided with an AliveCor heart monitor (AHM) case and a traditional transtelephonic monitor (TTM). Patients were asked to record their rhythm using both monitors simultaneously whenever they had symptoms or at least once a week. AHM recordings were sent to a secure e-mail account, and TTM recordings were transmitted to our Holter laboratory using landlines. All AHM recordings were reviewed by 1 of 2 blinded electrophysiologists. TTM recordings were reviewed by the primary electrophysiologist. The κ coefficient was calculated to assess agreement between AHM and TTM recordings. Sensitivity and specificity for the detection of AF and atrial flutter with the AHM compared to the TTM were calculated.

      Results

      Sixty patients were enrolled (mean age 60 ± 12 years), and 55 completed the study. There were 389 simultaneous AHM and TTM recordings. The κ statistic was 0.82, indicating excellent agreement between AHM and TTM recordings. If we consider AF and atrial flutter as one diseased state, the AHM had 100% sensitivity and 97% specificity for the detection of AF and atrial flutter. Only 2% of patients found it difficult to use the AHM, and the large majority (92%) preferred to use the AHM to monitor their AF as opposed to the TTM.

      Conclusion

      The AHM is an alternative method for monitoring patients with AF after the ablation procedure. Most patients found it easy to use.

      Abbreviations:

      AF (atrial fibrillation), AHM (AliveCor heart monitor), ECG (electrocardiographic/electrocardiogram), TTM (traditional transtelephonic monitor)

      Keywords

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      References

      1. Mobile Technology Fact Sheet. Pew Research Center Web site. http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/. Accessed December 29, 2014

      2. Smartphone for every five people in the world. Business Insider Web site. http://www.businessinsider.com/15-billion-smartphones-in-the-world-22013-2. Published February 8, 2013. Accessed December 29, 2014

      3. Columbus L. IDC: 87% of connected devices sales by 2017 will be tablets and smartphones. Forbes Web site. http://www.forbes.com/sites/louiscolumbus/2013/09/12/idc-87-of-connected-devices-by-2017-will-be-tablets-and-smartphones/. Published December 9, 2013. Accessed December 29, 2014.

      4. Smart connected devices in emerging markets to surpass 1 billion unit shipments by 2014 with more than 60% going to BRIC countries. International Data Corportation Web site http://www.businesswire.com/news/home/20130610005253/en/Smart-Connected-Devices-Emerging-Markets-Surpass-1. Accessed December 29, 2014

      5. AliveCor Web site. http://www.alivecor.com/home. Accessed December 29, 2014

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