(P112) COMPARATIVE ANALYSIS OF A WEARABLE ELECTROCARDIOGRAPH REPORTING TECHNOLOGY AND HOLTER MONITOR IN CARDIAC MONITORING: A PROSPECTIVE STUDY

Background: The continuous monitoring of cardiac rhythm is crucial in diagnosing arrhythmias and managing cardiovascular health, given the significant prevalence of arrhythmias in healthy populations and patients with cardiovascular disease. Holter monitors are the gold standard in non-invasive monitoring and detection of arrhythmias; however, their discomfort and inability to be worn for extended periods can limit their usability. We evaluated a new smart clothing device that allows for continuous electrocardiographic (ECG) monitoring and compared this device to the conventional Holter monitor.

METHODS AND RESULTS: Thirty-four patients were prospectively recruited from an outpatient cardiology clinic where they simultaneously wore both a Holter monitor in addition to a Hexoskin Smart Clothing (HSC), providing continuous 1-lead ECG recording for 24 hours. Data was collected from the Holter monitor through standard detection systems, while data from the HSC was obtained via remote transmission of ECG signals, compiled into a formal report and confirmed by physician overread. Pearson correlation analysis was used to compare data from both groups.

In 34 patients, the mean age was 56.0±16.5 years, 52.9% female, with ethnicities including Caucasian (52.9%), Asian (29.4%), and African-American (5.9%). The average BMI was 27.3±6.5 kg/m2 and 23.5% had atrial fibrillation or flutter. The median average heart rate (HR) was 69 bpm (interquartile range [IQR] 64-75 bpm), minimum HR was 46.5 bpm (IQR 40-52 bpm), and maximum HR was 111.5 bpm (IQR 103-130 bpm). Average sensitivities and positive predictive values for R-wave peak detection using the HSC were 89.1±24.5% and 96.7±17.1%, respectively.

Comparative results at 24 hours between HSC and Holter monitor demonstrated good correlation across parameters (p < 0.001 for all), including total number of QRS complexes (r=0.6), average HR (r=0.95), minimum HR (r=0.96), maximum HR (r=0.72), total pauses (r=0.96), longest pause (r=0.94), single ventricular ectopic (VE) beats (r=0.92), VE couplets (r=0.89), VE percentage (r=0.99), single supraventricular ectopic (SVE) beats (r=0.99), SVE couplets (r=0.98), SVE percentage (r=0.99), and long R-R intervals (r=1). There was no difference between HSC and Holter monitor performance in measuring the average, minimum, and maximum HR when stratified by age, gender, or shirt size (p>0.05 for all).

Conclusion: HSC performs comparably to the Holter monitor in ambulatory heart rate monitoring and arrhythmia detection. HSC presents a convenient and non-invasive alternative for continuous cardiac monitoring, potentially enhancing patient comfort and compliance. Further studies with larger sample sizes are warranted to validate these findings and explore the broader clinical implications of smart clothing in cardiology practice.