Efficacy of an Automatic and Patient-Triggered Ambulatory Cardiac Event Recorder
in the Evaluation of 101 Patients with Palpitations or Syncope
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.
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.
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
Toronto May 9
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