Handheld single lead electrocardiogram devices

Topic Status Complete

Handheld single lead electrocardiogram devices to detect atrial fibrillation in older adults and those with intermittent episodes

Outcome of the appraisal


The HTW Assessment Group considered the evidence presented in Evidence Appraisal Report 028. They concluded that there was not sufficient evidence to support the development of Guidance by the HTW Appraisal Panel and they did not see merit in HTW providing additional economic modelling. Due to this, they recommended publication of the appraisal as an Evidence Summary.

Why was this topic appraised?


Atrial fibrillation (AF) is an abnormal heart rhythm and is characterised by rapid and irregular beating of the atrial chambers of the heart resulting from structural and electrical causes. It is the most common cardiac arrhythmia and is associated with a range of serious health outcomes, including stroke and heart failure. Handheld single-lead (lead-I) electrocardiogram (ECG) devices have been developed to rapidly assess heart rhythm using portable devices.


Health Technology Wales (HTW) was asked to consider use of this technology in screening by partners working in a Local Health Board in Wales. An evidence review was completed to address the three following questions: 1) What is the diagnostic accuracy of handheld lead-I ECG for the detection of atrial fibrillation?; 2) What is the effectiveness of handheld lead-I ECG devices in single point of time screening for unknown AF in people aged over 65 in primary care and the community; 3) What is the effectiveness of handheld lead-I ECG devices to detect intermittent atrial fibrillation after an inconclusive clinical examination?

Plain language summary


Atrial fibrillation (AF) is an abnormal heart rhythm. This can occur when there is an issue with the structure of the heart. It can also occur if there are problems with electrical signals that control the heart. The result is a fast and irregular heart rhythm. It is the most common abnormal heart rhythm. Episodes can last for more than seven days (persistent AF) or vary in frequency and length (intermittent AF). AF can resolve without treatment in the early stages, but episodes can gradually get worse over time. This means that episodes of intermittent AF can become more permanent and become less easily treated. People with AF can sense that their heart rate is too fast, irregular, or is skipping beats and it sometimes causes chest pain and fatigue. However, AF often does not cause symptoms and can go undetected for long periods of time. If left untreated, AF is a major risk factor for stroke, in heart failure and other heart diseases and there is some evidence that AF is associated with increased rates of dementia.


Handheld single-lead (lead-I) electrocardiogram (ECG) devices have been developed to assess heart rhythm using portable devices. There are many different types of devices, but most follow the same basic set-up. Fingers or thumbs from both hands are attached to two sets of electrodes. The hardware then takes a reading of heart rhythm that can be used to assess AF.


Health Technology Wales looked for evidence on lead-I ECG devices to help assess if they are beneficial. HTW focused on two groups of people who might benefit from the devices. 1) People aged 65 or over who may have undetected AF that could be identified in primary care or community settings. 2) People with symptoms of AF that come and go and have inconclusive results from assessment. At-home use of devices when symptoms appear may be useful for this group.

Topic Exploration Report

TER173 04.2020

Evidence Appraisal Review

EAR028 04.2021

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