Scott Kinlay, MBBS, PhD, FRACP; James W. Leitch, MBBS, FRACP; Amanda Neil, BSc; Barry L. Chapman, MBBS, FRACP; David B. Hardy, DMU, RDCS; Peter J. Fletcher, MBBS, PhD, BMed(Sci), FRACP
To compare the diagnostic yield and cost-effectiveness of transtelephonic event monitors with those of Holter monitoring in patients with intermittent palpitations.
Randomized crossover trial.
Diagnostic service of a teaching hospital and surrounding primary care practices.
43 patients with previously uninvestigated palpitations who were referred for Holter monitoring.
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.
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.
Holter monitoring is a poor diagnostic test for intermittent palpitations. Event recorders provide better data and are more cost-effective.
Kinlay S, Leitch JW, Neil A, et al. Cardiac Event Recorders Yield More Diagnoses and Are More Cost-effective than 48-Hour Holter Monitoring in Patients with Palpitations: A Controlled Clinical Trial. Ann Intern Med. 1996;124:16–20. doi: https://doi.org/10.7326/0003-4819-124-1_Part_1-199601010-00003
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Published: Ann Intern Med. 1996;124(1_Part_1):16-20.
Cardiac Diagnosis and Imaging, Cardiology.
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