“Off-label use” of the tele-ECG event recorder for the detection of ST-abnormalities
Fabian Knebel, Agathe Konietzko, Sebastian Winkler, Alicija Dranenkienë, Parwis Fotuhi, Karl Stangl, Gert Baumann, Friedrich Köhler
Seminars in Cardiovascular Medicine 2009; 15: 5

Objective: Tele-ECG event recorders help classifying symptomatic rhythm disturbances. The ST-segment analysis was not a focus of these devices. Early diagnosis of ST-segment abnormalities in the home environment in patients at risk is important. The aim of this pilot study was to describe the potential ST-segment analysis of the tele-ECG compared to the standard 12-lead ECG.
Design and Methods: The credit-card sized tele-ECG event recorder (SM100, VitaphoneR, Germany) was used in 23 patients with ST-segment abnormalities in the standard 12-lead ECG (20 males, aged 43–79 years: 13 – post-CABG, 10 – with acute coronary syndromes prior to percutaneous coronary interventions). These patients underwent 30 sec tele-ECG recordings in three chest positions to validate the diagnostic accuracy of the tele-ECG compared to the 12-lead ECG in terms of ST-segment abnormalities.
Results: During the study, 56 tele-ECGs out of 23 patients were recorded. No tele-ECG required retransmission. Forty eight (85.7%) of the recorded tele-ECGs were of sufficient quality for diagnostic evaluation and 8 – were considered to be of poor quality because of the poor contact of the electrodes. The comparison of the tele-ECGs with the standard 12-lead ECGs showed a diagnostic sensitivity of 88% of ST-segment elevations and 77% of ST-segment depressions.
Conclusion: This is the first pilot study analysing the application of the tele-ECG compared to the 12-lead ECG in the detection of ST-segment changes. Newer devices with continuous mobile phone transmission should offer new options. Further investigations are needed to assess accurate transmission of ECG striving to improve the diagnosis and speed up adequate therapy in high-risk patients with acute myocardial infarction.

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