MCOT or ILR in Extended ECG Detection for Atrial Fibrillation

By Patrick Daly - Last Updated: October 6, 2022

In a recent analysis, researchers compared current modalities used for extended electrocardiogram (ECG) monitoring of atrial fibrillation after a cryptogenic stroke. According to the authors, mobile cardiac outpatient telemetry (MCOT) was more effective at detecting atrial fibrillation at 1 month compared with implantable loop recorders (ILRs). However, compliance became an issue for MCOT after 1 month. The study was published in Open Heart.

The researchers enrolled 47 studies with 6448 patients who had cryptogenic strokes or transient ischemic attacks and underwent ECG monitoring for a minimum of 24 hours. Enrolled patients also had a minimum atrial fibrillation duration of 30 seconds. The researchers used random-effects models to generate pooled estimates for detection of atrial fibrillation.

MCOT Advantaged Versus ILR in Month One

The report states that ILRs had a pooled atrial fibrillation detection rate of 4.9% (95% CI, 3.0–7.9%) at month 1 which increased to 38.4% (95% CI, 20.4–60.2%) at month 36. Comparatively, MCOT had a pooled atrial fibrillation detection rate of 12.8% (95% CI, 8.9–17.9%) at month 1 (P<.0001).

The authors noted that MCOT subjects had a shorter time to device implantation—and ILR patients may have further diagnostic measures for atrial fibrillation—which may exaggerate the difference at 1 month. Additionally, compliance failure, whether due to cognitive or physical impairment, was the primary limitation in MCOT’s effectiveness, the study found.

“In patients with sufficient cognitive and physical ability to carry out ECG monitoring daily, a 1-month duration of MCOT can capture a significant proportion of AF and should be considered in place of ILRs,” the article summarized, though the authors acknowledged that future research is needed on MCOT monitoring for atrial fibrillation.

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