A remarkable method was invented to detect atrial fibrillation using the ABPM (Ambulatory Blood Pressure Monitoring) device.
SIGNIFICANCE OF THE ABPM DEVICES
ABPM measures the blood pressure automatically & in a continuous manner while the patients perform daily activities. ABPM has the potential to provide the ability to detect white-coat or masked hypertension, determine nocturnal BP patterns, & evaluate the impact of various antihypertensive treatments. In 2020, the Global Ambulatory Blood Pressure Monitoring Devices (ABPM) Market’s share was nearly USD 103.27 Mn. It is estimated to reach a remarkable benchmark of around USD 207.55 million by 2030, representing a CAGR of 7.23% per cent throughout the estimated time frame of 2020-2030.
According to the National Library of Medicine, ABPM devices are also used to identify early-morning hypertension & excessive BP variability, both of which accurately correlate with target-organ damage & cardiovascular outcomes. In the case of the larger outcomes trials, ABPM sub-studies are carried out widely to help further understand the various patient outcomes. However, it is evident that the control of BP over the full 24-hr period, particularly during the risky early morning period, isn’t being achieved by conducting general practices.
IMPACT OF ATRIAL FIBRILLATION
A research study was conducted to study the accuracy of a 24-hr ambulatory blood pressure monitoring (ABPM) device with the help of a new irregular heartbeat (IHB) algorithm for the detection of atrial fibrillation (AF) during each BP measurement.
A total count of 90 patients with a history of elevated BP & some type of arrhythmia (i.e. an age range of (63-73) years; nearly 94% with hypertension; about 81 per cent with previously diagnosed AF) simultaneously underwent a thorough evaluation by 24-hr ABPM incorporated with the IHB (Irregular Heartbeat) algorithm & 24-hr Holter ECG (electrocardiography).
Out of the 3,347 valid readings, nearly 843 readings were considered to indicate an IHB. Among these IHB readings, almost (23.13%) or 195 readings were found to have an AF rhythm by the 24-hr Holter ECG. The IHB algorithm showed 79.4% specificity & 100% sensitivity for the accurate detection of AF rhythm.
An IHB was detected in approximately 12.1% of the overall measurements during normal rhythm, 48.8% of those were detected during premature atrial complex, and nearly 54.4% of those during the ventricular premature complex.
The percentage of IHBs that were discovered during normal rhythm was higher in the daytime as compared at night-time (16.3% vs 4.5%, respectively), suggesting that the daytime physical activities sometimes induce a false detection of the IHBs.
The optimal IHB parameters that existed for suggesting potential AF were:
- An IHB burden that is defined as a % of IHB-positive readings in total valid BP measurements in the range of >22.5% (85.1% specificity; 84.6% sensitivity, AUC 0.906, and p< 0.0001).
- Nearly 2.5 or more consecutive IHBs occurred during the conduction of 24-hour ABPM.
The novel 24-hr ABPM device coupled with the IHB algorithm has the potential to contribute to the future comprehensive management of the hypertensive patients, with its primary focus on the prevention of cerebrovascular events.
These ABPM devices are accurate enough for routine clinical usage for different types of patients. Some of the notable factors such as weight, gender, age, & severity of hypertension are statistically associated with higher device errors, but the differences are small and are much unlikely to affect the clinical practices that are conducted throughout the world.