The first device able to record single-lead ECG for 24 hours was created in 1961, Norman J. Holter invented a 75-lb backpack with a reel-to-reel FM ECG tape recorder, analog patient interface electronics, and large batteries. Nowadays, conventional ECG monitoring multi-lead portable ECG monitoring devices can register and store heartbeat data from 24 to 48 hours.

The next-generation ambulatory cardiac monitoring service, the ‘Smart Band-Aid’, looks similar to a 2-by-5-inch adhesive bandage and sticks to a patient’s chest. With beat-to-beat, real-time analysis, automatic arrhythmia detection, and wireless ECG transmission; continuously cardiac monitor records for up to 14 days with no need to remove it during exercise, sleeping, or bathing.

 

Candidates for Long Term Continuous ECG Monitoring:

• Patients with transient or intermittent symptoms
• Patient with known or suspected abnormal arrhythmias
• Patient monitoring post-stroke
• Monitoring a patient post PCI or bypass surgery
• Post-ablation procedure evaluation
• Monitoring for early detection & management of Atrial Fibrillation
• Monitoring a patient when prior ECG or 24-hour Holter study is inconclusive

 

The combination of big data and artificial intelligence (AI).

The open access to ECG databases has led to the development of many methods and approaches for computer-aided ECG arrhythmia classification over the last decades.
Abioro uses a deep convolutional neural network for ECG-Based Heartbeat Classification and Arrhythmia Detection.
The algorithms, after the learning process, may differentiate between 10 different arrhythmias as well as a normal heart rhythm with accuracy above 95%.
It could also tell the difference between irregular heart rhythms and background “noise” caused by interference of one kind or another.

Clinical significance

Although 24-hour Holter monitoring is routinely used for patients with suspected paroxysmal arrhythmia, 14 days continuous monitoring devices can detect and quantify asymptomatic arrhythmias and provide higher detection rates of relevant arrhythmias.
The PAC burden disorder - "premature atrial contractions (%)" - was defined as the total number of PACs over the total beats in a period of 14 days. Patients with a high PAC burden (>500/24 h) on Holter monitor should be considered at increased risk for developing AF and be educated on the symptoms of AF. Is recommended for patients with a high PAC burden careful control of hypertension, weight loss, and screening for sleep apnea.
Some studies report the 14-day ECG patch that its rates of detection of relevant arrhythmias on days 1, 3, 7, and 14 were 13%, 28%, 47%, and 66%, respectively.

Patient experience 

The dermal response score immediately after removing the 14-day patch indicated minimal erythema (barely perceptible).

 Patients reported a good experience because it is unobtrusive; may be worn while bathing or showering; can be removed by the patient at the end of the monitoring period, and collects and analyzes the data in the shortest effective time.

 

 Physician outcome

• Lower cost compared to other forms of long term ECG monitoring
• Reduce the need for repeat testing 
• An increase in a significant percentage of potentially high-risk arrhythmias not identified within 48-h of ambulatory ECG monitoring.
• Cloud-based report 

 

Profitability

That technology is one system! It requires wearable hardware, a trained AI algorithm, cloud-based report, and data management with security protocols; but despite that complexity, it is a simpler process for the customer chain. 
The hardware is cheaper than the 24 hours holter, the AI report provides the ECG segments with the diagnosis, which will cause higher productivity on physicians' electrocardiogram interpretation.
Some experiments in Japan with a group of vulnerable populations submitted to the holter 14 days suggest that the increase of asymptomatic detection with subsequent treatment decrease the health system cost plan.

 

Conclusion:

Adhesive Patch Electrocardiographic Monitoring long wear time allows more opportunity to capture cardiac arrhythmias that may not be recorded in a standard 24- to 48-hour Holter monitor.
These new devices have several advantages including light, small and waterproof design; efficient energy use and longer duration of monitoring, wireless data transfer, and no interruption of daily life over conventional Holter recorders. 
The Abioro Abioro mobile system data acquisition gets 1.411.200 RR intervals (considering 70 bpm) in 14 days; what makes the Diagnostic System ECG Viewer used for 24/48 Holter impractical to use, so it is required to develop an AI system for diagnosis.
Early detection and timely treatment of cardiac arrhythmias are critical for reducing the burden of cardiac disease, improving quality of life, and lowering healthcare costs.
Wearable patch monitors that record at least 8 days of ECG data appear to be the most well-tolerated and cost-effective devices.
The AI module potentially has a high accuracy compared to the trained cardiologists to classify a wide range of distinct arrhythmias. It can provide diagnosis results several days sooner compared with other providers.
The final line is that Adhesive Patch Electrocardiographic Monitoring medical technology has significantly better value them the 24/48 hours holter for all customer chain.