The use of a portable three-lead ECG monitor to detect atrial fibrillation in general practice

OBJECTIVE: To evaluate how well an inexpensive portable three-lead ECG monitor PEM identified patients with atrial fibrillation (AF) compared to a normal 12-lead ECG.

DESIGN: Cross-sectional method comparison study.

SETTING: From April 2014 to February 2015, we included patients coming to the general practice clinic "Lægerne Sløjfen", Aalborg, Denmark for a routine ECG. Patients with severe dementia, mental illness or poor ECG readings were excluded. After oral and written informed consent an ECG and PEM recordings were obtained simultaneously. The PEM recordings were analyzed by two general practitioners (GPs) in training and ECG recordings were evaluated by a senior GP and a cardiologist. Both the PEM and the ECG recordings were analysed blinded.

SUBJECTS: Ninety-three patients were included and four were excluded due to poor ECG readings.

MAIN OUTCOME MEASURES: The sensitivity and specificity of PEM compared to a standard 12-lead ECG.

RESULTS: Eighty-nine of the 93 (95.7%) patients had ECGs of a satisfactory technical quality and were included in the study. The sensitivity of diagnosing AF by PEM recordings was 86.7% and the specificity was 98.7% when compared to a 12-lead ECG. According to the cardiologist, the misclassification of three PEM recordings were due to interpretation errors and not related to the PEM recording per se.

CONCLUSIONS: The inexpensive portable PEM device recording diagnosed AF with a high sensitivity and specificity. KEY POINTS Simple ECG monitors could be useful to identify atrial fibrillation and thereby lead to a better prevention of stroke. The PEM device was easy to use and 95.7% of the recordings were technically acceptable for detecting atrial fibrillation. The PEM device has a high sensitivity and specificity in detecting atrial fibrillation compared to a standard 12-lead ECG. Further studies should evaluate the clinical usefulness of the PEM device, e.g. to detect intermittent atrial fibrillation.