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Personal ECG devices — a useful adjunctive tool to diagnose SVTs
Dr Shouvik Haldar
Royal Brompton & Harefield Hospital, London, UK
The ongoing COVID-19 pandemic has proven to be very challenging to patients and clinicians alike. Patients with supraventricular tachycardia (SVT) continued to present as new referrals to our service although many probably have not sought help for fear of attending hospitals and the potential for contracting the coronavirus.
The Royal Brompton & Harefield is a busy tertiary referral center, and all of our Electrophysiology Consultants perform outreach arrhythmia clinics throughout the region so that we are able to provide expertise to a large population. We actively seek to provide an efficient service to our SVT patients and for the large majority of patients, if we have caught the rhythm disturbance, will end up having an electrophysiological study with a view to a catheter ablation. SVT encompass certain types of arrythmias where catheter ablation can provide definitive treatment with very high success rates of around 90-95% with a single procedure.
Our care pathway ensures all patients fully understand their condition and all available options for treatment. If patients are eligible and wish to be considered for an interventional approach to their SVT we try and ensure this is done in a timely manner.
One of the challenges to diagnosing arrythmias during the COVID-19 pandemic is capturing them on an ECG recording system. To reduce footfall in the hospital we have sent many patients ECG recording monitors with video guidance on how to fit/wear them. We also have worked with an external company to provide a similar service where the monitor is delivered and also collected by the company. Once the monitor recordings are analyzed the results are sent back to the hospital.
Where relevant and suitable for patients we are also encouraging the use of personal ECG recording systems using for the example the Kardiamobile device or the Apple Watch, which empowers the patient to be in control of the data acquisition exactly when symptoms occur. The pros of this approach are that it allows for accurate symptom-rhythm correlation and is also not dependent on the symptoms occurring when the patient has a hospital prescribed ECG recoding monitor on. The downsides are that it requires the patient to purchase these devices although many are relatively inexpensive these days.
One such example is of a 36-year-old male patient who I saw just before the [UK] national lockdown who came to me with a history that was suggestive of an SVT. We discussed various options for catching this rhythm including getting a hospital monitor done but as his symptoms were infrequent but very pronounced when they occurred, I suggested a personal ECG device saying that this might reduce time to diagnosis. Indeed just a few weeks later he had another bout of palpitations and he borrowed his partners Apple Watch and recorded a very fast narrow complex tachycardia which was in keeping with an SVT (Figure 1). I was sent these strips and did not need to see him again in clinic to arrange an electrophysiological study whereupon he had successful curative treatment for his arrhythmia.
Results & conclusions:
We have used novel ways to improve diagnosis of arrythmias in patients with SVT including the increasing use of personal ECG devices during this current pandemic. These new methods are likely here to stay along with the concept of more widely accessible diagnostic hubs which is part of the NHS Future Plan. Ultimately having wider options and embracing the potential of digital health tools is likely to be beneficial for patients and physicians alike with hopefully shorter times to diagnosis and treatment.