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Cardiac Event Recorders Yield More Diagnoses and Are More Cost-effective than 48-Hour Holter Monitoring in Patients with Palpitations: A Controlled Clinical Trial

Scott Kinlay, MBBS, PhD, FRACP; James W. Leitch, MBBS, FRACP; Amanda Neil, BSc; Barry L. Chapman, MBBS, FRACP; David B. Hardy, DMU, RDCS; and Peter J. Fletcher, MBBS, PhD, BMed(Sci), FRACP
[+] Article and Author Information

From John Hunter Hospital and and Centre for Clinical Epidemiology and Biostatistics, New South Wales, Australia. Acknowledgments: The authors thank Helen Bednar, Fiona Broderick, Jenny Key, Jodie Pettit, Tammie Powell, and Mia Tolfree for technical assistance and Tammie Hodges for secretarial assistance. Requests for Reprints: Scott Kinlay, MBBS, PhD, FRACP, Cardiovascular Unit, John Hunter Hospital, Locked Bag 1, Hunter Mail Centre, New South Wales 2310, Australia. Current Author Addresses: Drs. Kinlay, Leitch, Chapman, Hardy, and Fletcher: Cardiovascular Unit, John Hunter Hospital, Locked Bag 1, Hunter Mail Centre, New South Wales 2310, Australia.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1996;124(1_Part_1):16-20. doi:10.7326/0003-4819-124-1_Part_1-199601010-00003
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Objective: To compare the diagnostic yield and cost-effectiveness of transtelephonic event monitors with those of Holter monitoring in patients with intermittent palpitations.

Design: Randomized crossover trial.

Setting: Diagnostic service of a teaching hospital and surrounding primary care practices.

Patients: 43 patients with previously uninvestigated palpitations who were referred for Holter monitoring.

Measurements: Patients were randomly allocated to receive an event monitor or 48-hour Holter monitor and then to receive the other device. Event monitors were used for 3 months or until two recordings were obtained while symptoms occurred. The main end point was an electrogram recorded during symptoms. The incremental cost-effectiveness of obtaining a diagnostic rhythm strip from event monitors was compared with that of Holter monitoring.

Results: The mean (±SD) patient age was 45 ± 19 years; 37 patients (88%) were women. Event monitors were twice as likely to provide a diagnostic rhythm strip electrocardiogram during symptoms as 48-hour Holter monitoring (29 patients [67%] and 15 patients [35%], respectively; P < 0.001). Event monitors detected 8 patients (19%) with clinically important arrhythmias (6 patients with supraventricular tachycardia and 2 with atrial fibrillation or flutter), whereas the Holter monitors detected no significant arrhythmia (P < 0.005). With the event monitors, most patients transmitted an electrocardiogram recording by 6 weeks. Event monitors were dominant and therefore more cost-effective than 48-hour Holter monitoring, resulting in a cost savings of $213 for each additional diagnostic rhythm strip obtained during symptoms.

Conclusions: Holter monitoring is a poor diagnostic test for intermittent palpitations. Event recorders provide better data and are more cost-effective.

Figures

Grahic Jump Location
Figure 1.
Electrocardiogram recording from an event recorder showing atrial fibrillation during palpitations.
Grahic Jump Location
Grahic Jump Location
Figure 2.
Cumulative number of patients who sent an electrocardiogram from an event recorder by the number of days needed to record an electrocardiogram while symptoms were occurring.
Grahic Jump Location

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