Dr Saeedur Rahman
Consultant Stroke Physician, Darent Valley Hospital, Dartford and Gravesham NHS Trust
Stroke doctors redesign arrhythmia pathways with an advanced AI heart monitor that detects arrhythmias more effectively.
Atrial fibrillation (AF) is the most common type of arrhythmia, a condition where the heart rhythm is either irregular, too fast or too slow. It’s a leading cause of stroke — and can be difficult to diagnose.
Wearable monitoring devices for arrhythmia
“We ask patients with suspected AF to wear heart monitoring devices to pick up abnormal rhythms,” explains Dr Saeedur Rahman, Consultant Stroke Physician, Darent Valley Hospital, Dartford and Gravesham NHS Trust. “However, this can be complicated by a type of AF called paroxysmal atrial fibrillation because symptoms can come and go.”
Conventional ECG monitors (holter monitors) are usually only worn for 24 hours or up to seven days; so, if patient does not develop abnormal rhythm during that time, the condition could be missed. Plus, holters are cumbersome, so patient compliance can be low. For hospital staff, it’s labour-intensive, as a cardiac physiologist has to manually assess large ECG datasets recorded by the devices.
We ask patients with suspected AF to wear heart
monitoring devices to pick up abnormal rhythms.
Dr Rahman and team following an internal review of pathway, felt that in between a 12 lead ECG and an implantable loop recorder (ILR), there need to be an intermediary duration of rhythm monitoring. The team decided to redesign their pathway to provide another option before ILR, “We needed a monitoring device that was somewhere between a traditional monitor and implantable loop recorder,” says Dr Rahman.
Varied benefits of monitoring for longer
The team identified an advanced, AI-enabled ECG monitoring service, Zio XT service from iRhythm Technologies, which consists of the Zio monitor worn for up to 14 days, AI with Cardiac Physiologist analysis and an ECG report. “Longer monitoring times are better because the pick-up rates are higher, and there are fewer false readings,” notes Dr Rahman.
Darent Valley experienced several other benefits through the redesigned pathway. First, the Zio XT device is smaller and showerproof, unlike traditional holter monitors, resulting in improved patient compliance. Second, datasets are analysed by AI and iRhythm’s team of Cardiac Physiologists, leading to faster diagnosis and reduced burden on hospital staff.
This is good for patients who need treatment quickly since they are diagnosed faster compared to typical holter practice; potentially reducing secondary strokes and the associated costs. It’s also good for the NHS by increasing capacity and productivity through reduced need to repeat tests.
“Clinicians need to use it in the right context and embed it in a very structured pathway,” says Dr Rahman. “We succeeded because we planned well and partnered with iRhythm to ensure we had the right staff training and evaluated our progress throughout.”
This represents Dr. Rahman’s experience at his facility and my not reflect every facility experience. Adopting Adhesive Single lead Cardiac Patch in Improving rhythm analysis strategy for patients with TIA and Ischaemic strokes, A. Ahad 1, P. Aghoram 2, S. Botes 3, S. Rahman 4, Poster from ESOC 2023
