New wearable options for pacemaker patients monitoring: t-shirt and thoracic band approach vs traditional holter comparison

Wearable devices provide new diagnostic options for evaluating dysfunctions in patients with cardiac devices. Currently, for pacemaker patients, surface electrocardiography, such as 12-lead ECG and Holter monitoring, are used to distinguish between intrinsic and pacemaker-induced rhythm, which is vital for device-troubleshooting. New platforms that offer a more comfortable continuous recording are interesting, but signal quality requires clarification.

The objective of this study is to evaluate the quality of a tshirt based (VJ device) and a thoracic band (LO device) tracings in a population of cardiac devices patients, documenting whether the acquired signal allows for distinguishing intrinsic rhythm from paced rhythm like the 12-lead ECG. Additionally, it aims to quantify the impact of noise on signal interpretation during ambulatory use and evaluate the comfort of these devices compared to traditional Holter monitoring.

This observational clinical study included 35 patients (age 74±15 years, 48.6% female) who used one of the tested wearables (VJ n=16, LO n=19). The QRS width assessed through the wearables was similar to the 12-lead ECG (picture 1): for paced rhythm, it was 167 vs. 167 ms, and for intrinsic rhythm, it was 111 vs. 113ms, respectively. Thus, in the tracings obtained by the wearables, the QRS width in paced rhythm was significantly larger than in intrinsic rhythm (paced 167.2±19.9 ms and intrinsic 110.5±15.8ms, p<0.001), allowing its diferentiation as in the 12-lead ECG. In picture 1 an example of the obtained tracings is available: the pannel A shows intrinsic rythm for the same patient in the ECG (up, blue tracing) and the LO (down, black tracing) and pannel B shows the same patient tracings in paced rythm on the ECG (up, blue tracing) and LO (down, black tracing).

Regarding the impact of noise during ambulatory use, the average analysis time per patient was 27.9 hours, with 82.7% of the tracing being analysable. The comfort questionnaire demonstrated that most patients preferred the wearable devices (75% VJ and 95% LO vs. traditional Holter monitoring, p<0.001).

In conclusion, both VJ and LO provide adequate signal quality to be applied in troubleshooting and have patient preference for being more comfortable than traditional Holter monitoring.

A) intrinsic rythm and B) paced rythm