Background: There is insufficient evidence for the use of single-lead electrocardiogram (ECG) monitoring with an adhesive patch-type device (APD) over an extended period compared to that of the 24-hour Holter test for atrial fibrillation (AF) detection. Objective: In this paper, we aimed to compare AF detection by the 24-hour Holter test and 72-hour single-lead ECG monitoring using an APD among patients with AF. Methods: This was a prospective, single-center cohort study. A total of 210 patients with AF with clinical indications for the Holter test at cardiology outpatient clinics were enrolled in the study. The study participants were equipped with both the Holter device and APD for the first 24 hours. Subsequently, only the APD continued ECG monitoring for an additional 48 hours. AF detection during the first 24 hours was compared between the two devices. The diagnostic benefits of extended monitoring using the APD were evaluated. Results: A total of 200 patients (mean age 60 years; n=141, 70.5% male; and n=59, 29.5% female) completed 72-hour ECG monitoring with the APD. During the first 24 hours, both monitoring methods detected AF in the same 40/200 (20%) patients (including 20 patients each with paroxysmal and persistent AF). Compared to the 24-hour Holter test, the APD increased the AF detection rate by 1.5-fold (58/200; 29%) and 1.6-fold (64/200; 32%) with 48- and 72-hour monitoring, respectively. With the APD, the number of newly discovered patients with paroxysmal AF was 20/44 (45.5%), 18/44 (40.9%), and 6/44 (13.6%) at 24-, 48-, and 72-hour monitoring, respectively. Compared with 24-hour Holter monitoring, 72-hour monitoring with the APD increased the detection rate of paroxysmal AF by 2.2-fold (44/20). Conclusions: Compared to the 24-hour Holter test, AF detection could be improved with 72-hour single-lead ECG monitoring with the APD.

There are few reports on head-to-head comparisons of electrocardiogram (ECG) monitoring between adhesive single-lead and Holter devices for arrhythmias other than atrial fibrillation (AF). This study aimed to compare 24 h ECG monitoring between the two devices in patients with general arrhythmia. Twenty-nine non-AF patients with a workup of pre-diagnosed arrhythmias or suspicious arrhythmic episodes were evaluated. Each participant wore both devices simultaneously, and the cardiac rhythm was monitored for 24 h. Selective ECG parameters were compared between the two devices. Two cardiologists independently compared the diagnoses of each device. The two most frequent monitoring indications were workup of premature atrial contractions (41.4%) and suspicious arrhythmia-related symptoms (37.9%). The single-lead device had a higher noise burden than the Holter device (0.04 ± 0.05% vs. 0.01 ± 0.01%, p = 0.024). The number of total QRS complexes, ventricular ectopic beats, and supraventricular ectopic beats showed an excellent degree of agreement between the two devices (intraclass correlation coefficients = 0.991, 1.000, and 0.987, respectively). In addition, the minimum/average/maximum heart rates showed an excellent degree of agreement. The two cardiologists made coherent diagnoses for all 29 participants using both monitoring methods. In conclusion, the single-lead adhesive device could be an acceptable alternative for ambulatory ECG monitoring in patients with general arrhythmia.

Kim J, et al. J Korean Med Sci. 2024 Jan;39:e56. https://doi.org/10.3346/jkms.2024.39.e56

Background and Objectives: Few comparative studies have evaluated wearable single-lead electrocardiogram (ECG) devices and standard multi-lead ECG devices during exercise testing. This study aimed to validate the accuracy of a wearable single-lead ECG monitor for recording heart rate (HR) metrics during graded exercise tests (GXTs). Methods: A cohort of 50 patients at a tertiary hospital underwent GXT while simultaneously being equipped with wearable single- and conventional multi-lead ECGs. The concordance between these modalities was quantified using the intraclass correlation coefficient and Bland–Altman plot analysis. Results: The minimum and average HR readings between the devices were generally consistent. Parameters such as ventricular ectopic beats and supraventricular ectopic beats showed strong agreement. However, the agreement for the Total QRS and Maximum RR was not sufficient. HR measurements across different stages of the exercise test showed sufficient agreement. Although not statistically significant, the standard multi-lead ECG devices exhibited higher noise levels compared to the wearable single-lead ECG devices. Conclusions: Wearable single-lead ECG devices can reliably monitor HR and detect abnormal beats across a spectrum of exercise intensities, offering a viable alternative to traditional multi-lead systems.

A cardiopulmonary exercise test (CPET) is essential for lung resection. However, performing a CPET can be challenging. This study aimed to develop a machine learning model to estimate maximal oxygen consumption (VO_2max) using data collected through a patch-type single-lead electrocardiogram (ECG) monitoring device in candidates for lung resection. This prospective, single-center study included 42 patients who underwent a CPET at a tertiary teaching hospital from October 2021 to July 2022. During the CPET, a single-lead ECG monitoring device was applied to all patients, and the results obtained from the machine-learning algorithm using the information extracted from the ECG patch were compared with the CPET results. According to the Bland–Altman plot of measured and estimated VO_2max, the VO_2max values obtained from the machine learning model and the FRIEND equation showed lower differences from the reference value (bias: −0.33 mL·kg⁻¹·min⁻¹, bias: 0.30 mL·kg⁻¹·min⁻¹, respectively). In subgroup analysis, the developed model demonstrated greater consistency when applied to different maximal stage levels and sexes. In conclusion, our model provides a closer estimation of VO_2max values measured using a CPET than existing equations. This model may be a promising tool for estimating VO_2max and assessing cardiopulmonary reserve in lung resection candidates when a CPET is not feasible.

Cancer remains a leading cause of mortality worldwide. Chemotherapy is effective but can cause febrile neutropenia, deplete neutrophils, and increase infection risk. Although timely fever detection is critical to prevent complications, periodic temperature monitoring has inherent limitations. Wearable devices (WDs) for real-time body temperature (RBT) monitoring are emerging as tools for early fever detection, though their clinical feasibility and usability remain unverified. This study assessed the clinical feasibility of a novel WD by comparing its temperature concordance and fever detection capability against a standard reference in patients with cancer. The RBT system’s clinical maturity, including its capacity for early fever detection and monitoring treatment-related changes, was evaluated. Furthermore, satisfaction among clinicians and patients was analyzed in a hospital setting. In this prospective study, patients with hematologic malignancies at high infection risk admitted to the Chonnam National University in Hwasun Hospital, South Korea, were enrolled. Data from 47 patients were analyzed to compare MT100D as WD (SEERS Technology Co., Ltd., South Korea) readings with axillary thermometers. Temperature concordance was evaluated using the intraclass correlation coefficient (ICC), and diagnostic performance was compared with the reference thermometer. The early fever detection performance of the MT100D was analyzed to evaluate the clinical effectiveness of the early response system. Usability was evaluated through a five-point Likert scale survey completed by clinical nurses. The MT100D demonstrated good agreement with the reference thermometer (mean difference: −0.19 ± 0.35 °C; ICC: 0.78). The RBT system achieved sensitivity, specificity, and area under the receiver operating characteristic curve values of 81.50%, 96.32%, and 96.60%, respectively. The early fever detection rate was 77.1%, with the RBT system detecting fever an average of 1.13 ± 1.28 h earlier than the reference. Usability and satisfaction assessments showed high patient satisfaction (mean 4.69 ± 0.5; range 4.57–4.80) and moderate clinician satisfaction (mean 3.63 ± 0.75; range 2.89–4.11). Among patients with cancer, including those at risk of febrile neutropenia, the MT100D demonstrated strong concordance with standard thermometry, enabling early fever detection. The RBT system shows promise for the early identification of neutropenic risk during chemotherapy.