NOVACOR HOME CLINICAL APPLICATIONS R.TEST EVOLUTION EFFICIENCY DIAGNOSIS



R.TEST Evolution efficiency diagnosis


R.TEST EVOLUTION EFFICIENCY DIAGNOSIS

Efficacy of an Automatic and Patient-Triggered Ambulatory Cardiac Event Recorder in the Evaluation of 101 Patients with Palpitations or Syncope


Efficacy of an Automatic and Patient-Triggered Ambulatory Cardiac Event Recorder in the Evaluation of 101 Patients with Palpitations or Syncope

Nicola Balmelli, MD, Barbara Naegeli, MD, Osmund Bertel, MD.
Division of Cardiology, Triemli Hospital, Zurich, Switzerland.

Cardiac event recorders (CER) have an increased diagnostic yeld and are more cost-effective than conventional 24h-Holter ECGs for the evaluation of sporadic (<1x/d), potentially rhythmogenic symptoms.
The aim of this study was to determine:

1) The efficacy of a patient-triggered CER with a continuous automatic arrhytmia detection function (R.TEST Evolution, monitoring capabilities up to 7 days) in the evaluation of sporadic dizziness/syncope (Di/Sy) and palpitations (Pa).

2) Its clinical relevance in assessing further management.

Results
101 consecutives pts (54+-20yrs, 40 females), referred to our cardiology unit for the evaluation of sporadic Di/Sy (36%) and Pa (64%), were prospectively investigated. After a mean monitoring period of 103+-38h, 83 pts registered symptoms and 57 pts had diagnostic or therapeutic relevant arrhythmias (relA). Totally 196 episodes of relA were recorded: 8 VTs, 14 V-bigeminus, 33 atrial fibrillation/flutter, 92 SVTs, 49 pauses (>=3s)/bradycardia (<40bpm). 31 (16%) episodes were patient-triggered and 165 (84%) automatically recorded. Diagnostic relevant episodes (relA and/or typical symptoms) occured in 94 pts, in 54% after the first 24 hours of monitoring. According to the results of the CER, 80 pts had no need for further evaluation, 20 pts had additional diagnostic tests (3 ventr. EP-studies, 3 tilt tests, 3 neurol. evaluations, 1 cardiac-MRI, 2 laboratory, 6 repeated R.TESTs, 2 24h-Holter ECGs). Device set up and data interpretation took about 45min, less than for a conventional 24h-Holter ECG.

Conclusions
A CER with a continuous automatic arrhythmia detection function is a well tolerated, easy and cost-effective device for sporadic, potentially rhythmogenic symptoms. The patient-triggered mode alone is not sufficiently reliable, the automatic continuous arrhythmia detection function has diagnostic and therapeutical consequences. In 54% of the pts the first diagnostic event would not have been recorded with a single conventional 24h-Holter ECG.

NASPE – Toronto – May 9

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