Prospective comparison of the diagnostic utility of a standard event monitor versus a ‘leadless’ portable ECG monitor in the evaluation of patients with palpitations
Abstract
Introduction Current ambulatory ECG monitoring systems are limited in their ability to diagnose patients with palpitations. The aim of this prospective study was to compare a new "leadless" ambulatory monitor with a standard event monitor in the evaluation of patients with palpitations.Methods Eighteen consecutive patients (11 female, 56 +/- 16 years) referred for evaluation of palpitations were provided with both a standard event monitor and a "leadless" monitor for 30 days. They were asked to record episodes of palpitations with both monitoring devices.Results All 18 individuals were compliant with the "leadless" monitor for the 30-day period while only 14 (78%) patients were compliant with the standard event monitor (p = 0.10). During a combined monitoring period of 563 days, 159 symptomatic episodes were recorded with the "leadless" ECG monitor (8.8 +/- 9.7 per patient, range 1-35) and 169 symptomatic episodes were recorded with the event monitor (12 +/- 8.3 per patient, range 1-33) (p = NS). The "leadless" ECG monitor recorded arrhythmias in 13 of 18 patients (72%) and the standard event monitor recorded arrhythmias in 8 of 14 patients (57%) (p = NS).Conclusion The "leadless" ECG monitor is associated with high patient compliance and results in high quality ECG recordings. The diagnostic yield of this monitoring system is equivalent to a standard event monitor.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Event recorders or handheld patient-operated ECG systems improve the diagnosis of transient ECG changes in patients with palpitations.
“Event recorders or handheld patient-operated ECG systems have been shown to improve the diagnosis of transient ECG changes in patients with palpitations.71,72”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [71]
In patients with daily or weekly symptoms, external loop recorders and event recorders have higher diagnostic value (66-83%) and better cost/effectiveness than Holter devices.
“By contrast, in patients in whom the symptoms are quite frequent (i.e.daily or weekly), external loop recorders and event recorders have shown both a higher diagnostic value (66 -83%) and a better cost/effectiveness ratio than Holter devices.71,83”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [71]
In patients with symptoms of possible arrhythmic origin, mobile cardiac outpatient telemetry has higher diagnostic value than other external devices.
“Finally, in patients with symptoms of possible arrhythmic origin, mobile cardiac outpatient telemetry has been seen to exhibit a higher diagnostic value than the other external devices.71,84,85”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [71]
A small percentage of patients with palpitations of unknown origin have major bradyarrhythmic disorders, such as severe sinus bradycardia and paroxysmal advanced atrioventricular block.
“Finally, a small percentage of patients with palpitations of unknown origin have major bradyarrhythmic disorders, such as severe sinus bradycardia and paroxysmal advanced atrioventricular block.52,71”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [71]
Cites
Robinson, R. (1993) · BMJ · doi:10.1136/bmj.307.6907.793 · Cited by 819 · see citing works
Kinlay, S., Leitch, J. W., Neil, A., Chapman, B. L., Hardy, D. B., & Fletcher, P. J. (1996) · Annals of Internal Medicine · doi:10.7326/0003-4819-124-1_part_1-199601010-00003 · Cited by 245 · cited 1× · see citing works
“Not surprisingly, studies have shown that the diagnostic yield of these monitors varies directly with the duration of monitoring [3, 4].”
BackgroundUse of ambulatory electrocardiographic (Holter) monitoring
DiMarco, J. P., & Philbrick, J. T. (1990) · Annals of Internal Medicine · doi:10.7326/0003-4819-113-1-53 · Cited by 177 · see citing works
Evaluation of patients with palpitations
Zimetbaum, P., & Josephson, M. E. (1998) · New England Journal of Medicine · doi:10.1056/nejm199805073381907 · Cited by 172 · see citing works
Sivakumaran, S., Krahn, A. D., Klein, G. J., Finan, J., Yee, R., Renner, S., & Skanes, A. C. (2003) · The American Journal of Medicine · doi:10.1016/s0002-9343(03)00233-x · Cited by 160 · cited 1× · see citing works
“The utility of event recorders is further limited by the observation that nearly one in four patients does not activate the recorder during symptomatic episodes despite previous education to do so [10].”
BackgroundVasamreddy, C. R., Dalal, D., Dong, J., Cheng, A., SPRAGG, D. D., Lamiy, S. Z., Meininger, G. R., Henrikson, C. A., Marine, J. E., Berger, R. D., et al. (2006) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2006.00359.x · Cited by 156 · see citing works
Self-citationThe Evolving Role of Ambulatory Arrhythmia Monitoring in General Clinical Practice
Zimetbaum, P. J., & Josephson, M. E. (1999) · Annals of Internal Medicine · doi:10.7326/0003-4819-130-10-199905180-00020 · Cited by 139 · see citing works
Zimetbaum, P. J., Kim, K. Y., Josephson, M. E., Goldberger, A. L., & Cohen, D. J. (1998) · Annals of Internal Medicine · doi:10.7326/0003-4819-128-11-199806010-00002 · Cited by 133 · see citing works
Brown, A. P., Dawkins, K. D., & Davies, J. G. (1987) · Heart · doi:10.1136/hrt.58.3.251 · Cited by 96 · see citing works
Utility and cost of event recorders in the diagnosis of palpitations, presyncope, and syncope
Fogel, R. I., Evans, J. J., & Prystowsky, E. N. (1997) · The American Journal of Cardiology · doi:10.1016/s0002-9149(96)00717-5 · Cited by 83 · see citing works
Diagnostic Utility of Memory Equipped Transtelephonic Monitors
Schmidt, S. B., & Jain, A. C. (1988) · The American Journal of the Medical Sciences · doi:10.1097/00000441-198811000-00002 · Cited by 17 · see citing works
Pj, Kim, K. W., Ky, Josephson, Me, & Goldberger (2009) · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Barrett, P. M., Komatireddy, R., Haaser, S., Topol, S., Sheard, J., Encinas, J., Fought, A. J., & Topol, E. J. (2014) · The American Journal of Medicine · doi:10.1016/j.amjmed.2013.10.003 · Cited by 498 · see citing works
A comprehensive survey of wearable and wireless ECG monitoring systems for older adults
Baig, M. M., Gholamhosseini, H., & Connolly, M. J. (2013) · Medical & Biological Engineering & Computing · doi:10.1007/s11517-012-1021-6 · Cited by 284 · see citing works
Searching for Atrial Fibrillation Poststroke
Schnabel, R. B., Hæusler, K. G., Healey, J. S., Freedman, B., Boriani, G., Brachmann, J., Brandes, A., Bustamante, A., Casadei, B., Crijns, H. J. G. M., et al. (2019) · Circulation · doi:10.1161/circulationaha.119.040267 · Cited by 248 · see citing works
Highly flexible, wearable, and disposable cardiac biosensors for remote and ambulatory monitoring
Lee, S. P., Ha, G., Wright, D. E., Ma, Y., Sen-Gupta, E., Haubrich, N. R., Branche, P. C., Li, W., Huppert, G. L., Johnson, M. D., et al. (2018) · npj Digital Medicine · doi:10.1038/s41746-017-0009-x · Cited by 229 · see citing works
Raviele, A., Giada, F., Bergfeldt, L., Blanc, J. J., Blomstrom-Lundqvist, C., Mont, L., Morgan, J. M., Raatikainen, M. J. P., Steinbeck, G., Viskin, S., et al. (2011) · Europace · doi:10.1093/europace/eur130 · Cited by 149 · see citing works
Kaleschke, G., Hoffmann, B., Drewitz, I., Steinbeck, G., Naebauer, M., Goette, A., Breithardt, G., & Kirchhof, P. (2009) · Europace · doi:10.1093/europace/eup262 · Cited by 81 · see citing works
A Survey on Psycho-Physiological Analysis & Measurement Methods in Multimodal Systems
Baig, M. Z., & Kavakli, M. (2019) · Multimodal Technologies and Interaction · doi:10.3390/mti3020037 · Cited by 77 · see citing works
Hendrikx, T., Rosenqvist, M., Wester, P. O., Sandström, H., & Hörnsten, R. (2014) · BMC Cardiovascular Disorders · doi:10.1186/1471-2261-14-41 · Cited by 73 · see citing works
Reed, M. J., Grubb, N. R., Lang, C. C., O'Brien, R., Simpson, K., Padarenga, M., Grant, A., Tuck, S., Keating, L., Coffey, F., et al. (2019) · EClinicalMedicine · doi:10.1016/j.eclinm.2019.02.005 · Cited by 57 · see citing works
de Asmundis, C., Conte, G., Sieira, J., Chierchia, G.-B., Rodriguez-Manero, M., Di Giovanni, G., Ciconte, G., Levinstein, M., Baltogiannis, G., Saitoh, Y., et al. (2014) · Europace · doi:10.1093/europace/eut411 · Cited by 52 · see citing works
Paroxysmal atrial fibrillation with silent episodes: Intermittent versus continuous monitoring
Doliwa, P. S., Rosenqvist, M., & Frykman, V. (2012) · Scandinavian Cardiovascular Journal · doi:10.3109/14017431.2012.661873 · Cited by 42 · see citing works
Invited Article: Emerging soft bioelectronics for cardiac health diagnosis and treatment
Ershad, F., Sim, K., Thukral, A., Zhang, Y. S., & Yu, C. (2018) · APL Materials · doi:10.1063/1.5060270 · Cited by 42 · see citing works
Chilukuri, K., Scherr, D., Dalal, D., Cheng, A., SPRAGG, D. D., Nazarian, S., Barcelon, B., Marine, J. E., Calkins, H. G., & Henrikson, C. A. (2011) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-011-9587-8 · Cited by 35 · see citing works
Self-citationBolourchi, M., & Batra, A. S. (2014) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2014.12.014 · Cited by 34 · see citing works
Fensli, R. W., Dale, J. G., O’Reilly, P., O’Donoghue, J., Sammon, D., & GUNDERSEN, T. (2009) · Journal of Medical Systems · doi:10.1007/s10916-009-9291-8 · Cited by 28 · see citing works
Park, M. H. K., de Asmundis, C., Chierchia, G., Sarkozy, A., Benatar, A. A., & Brugada, P. (2011) · EP Europace · doi:10.1093/europace/eur159 · Cited by 23 · see citing works
Diving Into Research of Biomedical Engineering in Scuba Diving
Cibis, T., McEwan, A. L., Sieber, A., Eskofier, B. M., Lippmann, J. M., Friedl, K. E., & Bennett, M. H. (2017) · IEEE Reviews in Biomedical Engineering · doi:10.1109/rbme.2017.2713300 · Cited by 23 · see citing works
(2017) · PubMed Central · Cited by 19 · see citing works
Antonicelli, R., Ripa, C., Abbatecola, A. M., Capparuccia, C., Ferrara, L., & Spazzafumo, L. (2012) · Journal of Telemedicine and Telecare · doi:10.1258/jtt.2011.110613 · Cited by 18 · see citing works
Reed, M. J., Grubb, N. R., Lang, C. C., O’Brien, R., Simpson, K., Padarenga, M., Grant, A., & Tuck, S. (2018) · Trials · doi:10.1186/s13063-018-3098-1 · Cited by 17 · see citing works
External Cardiac Loop Recorders: Functionalities, Diagnostic Efficacy, Challenges and Opportunities
Rajanna, R. R., Sriraam, N., Prakash, V. S. R., Vittal, P. R., Arun, U., & Sahoo, S. (2021) · IEEE Reviews in Biomedical Engineering · doi:10.1109/rbme.2021.3055219 · Cited by 17 · see citing works
Using a Cardiac Event Recorder in Children with Potentially Arrhythmia‐Related Symptoms
Saygı, M., Ergül, Y., Özyılmaz, İ., Şengül, F. S., Güvenç, O., Aslan, E., Güzeltaş, A., Akdeniz, C., & Tuzcu, V. (2016) · Annals of Noninvasive Electrocardiology · doi:10.1111/anec.12339 · Cited by 12 · see citing works
How often does spirometry testing induce cardiac arrhythmias?
de Araújo, C. G. S., & Vianna, L. C. (2009) · Primary Care Respiratory Journal · doi:10.4104/pcrj.2009.00023 · Cited by 12 · see citing works
Attanasio, P., Huemer, M., Loehr, L., Parwani, A. S., Boldt, L., Haverkamp, W., & Wutzler, A. (2015) · Annals of Noninvasive Electrocardiology · doi:10.1111/anec.12301 · Cited by 11 · see citing works
Quan, K. J. (2019) · Medical Clinics of North America · doi:10.1016/j.mcna.2019.05.005 · Cited by 11 · see citing works
Chang, W.-L., Hou, C. J., Wei, S.-P., Tsai, J., Chen, Y.-J., Chen, M., Chuech, C.-C., Hung, C., Huang, M.-Y., Lee, C.-H., et al. (2015) · International journal of gerontology · doi:10.1016/j.ijge.2015.06.002 · Cited by 9 · see citing works
Patient selection for ambulatory cardiac monitoring in the Indian healthcare environment
Shrivastav, M., Shrivastav, R., Makkar, J. S., & Biffi, M. (2013) · Heart Asia · doi:10.1136/heartasia-2012-010228 · Cited by 8 · see citing works
Altinsoy, M., Sutton, R., Kohno, R., Sakaguchi, S., Mears, R. K., & Benditt, D. G. (2021) · Journal of Arrhythmia · doi:10.1002/joa3.12560 · Cited by 7 · see citing works
Akça, T., Uysal, F., Bostan, Ö., Genç, A., & Türkmen, H. (2021) · Pediatric Cardiology · doi:10.1007/s00246-021-02705-y · Cited by 7 · see citing works
Multi-functional device for cardiologic telemedicine and diagnostic holter
Belardinelli, A., Muratori, L., Corazza, I., Magnalardo, M., Marangoni, F., & Zannoli, R. (2008) · Computers in cardiology · doi:10.1109/cic.2008.4749209 · Cited by 6 · see citing works
Self-Organized Operational Neural Networks for The Detection of Atrial Fibrillation
Zhang, J., Dong, H., Gao, J., Yao, R., Li, G., & Wu, H. (2023) · Journal of Artificial Intelligence and Soft Computing Research · doi:10.2478/jaiscr-2024-0004 · Cited by 5 · see citing works
A Patient‐Centered Approach to Cardiac Monitoring After Cryptogenic Stroke: A Review
Hassani, S., Husseini, N. E., Feng, W., Lloyd, M. S., & Quyyumi, A. A. (2024) · Stroke Vascular and Interventional Neurology · doi:10.1161/svin.123.001126 · Cited by 4 · see citing works
Kabe, I., Koga, Y., Kochi, T., & Mizoue, T. (2014) · Journal of Occupational Health · doi:10.1539/joh.14-0092-fs · Cited by 4 · see citing works
Enfoque semiológico de las palpitaciones
Gaviria, M. Á., Bustos, C. H., & Mora, G. (2014) · Revista de la Facultad de Medicina · doi:10.15446/revfacmed.v62n1.43779 · Cited by 3 · see citing works
Sriraam, N., & Chakravarty, P. (2023) · Critical Reviews in Biomedical Engineering · doi:10.1615/critrevbiomedeng.2023045334 · Cited by 2 · see citing works
Sensing Technologies for Biomedical Telemetry
Tamura, T. (2014) · Wiley eBooks · doi:10.1002/9781118893715.ch4 · Cited by 2 · see citing works
Bennett, M. R. J., Chaudhry, B., Norman, G., Robinson, T., Ternent, L., & Coats, L. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-110631 · Cited by 1 · see citing works
Emergency Tracking of the Heart Patients
P.Nemade, P., & Kulkarni Dr., G. A. (2019) · IJARCCE · doi:10.17148/ijarcce.2019.8536 · Cited by 1 · see citing works
Hendrikx, T. (2015) · KTH Publication Database DiVA (KTH Royal Institute of Technology) · Cited by 1 · see citing works
Long-Term ECG (Holter) Monitoring and Head-Up Tilt Test
Dora, S. K. (2013) · Springer eBooks · doi:10.1007/978-1-4471-5316-0_12
Harańczyk, M., Konieczyńska, M., & Płazak, W. (2017) · Current research. Cardiology · doi:10.4172/2368-0512.1000097
A Review on Remote Monitoring System for Moving Patients
P.Nemade, P., & Kulkarni, G. (2019) · IJARCCE · doi:10.17148/ijarcce.2019.8420
Bénali, K., & Guénancia, C. (2022) · EMC - Tratado de Medicina · doi:10.1016/s1636-5410(22)46832-2
Bénali, K., & Guénancia, C. (2022) · EMC - AKOS - Trattato di Medicina · doi:10.1016/s1634-7358(22)46915-4
Patient Driven EKG Device Performance in Adults with Fontan Palliation
Laubham, M., Dodeja, A. K., Kumthekar, R. N., Shay, V., D'Emilio, N., Conroy, S., Mah, M. L., Alvarado, C., & Kamp, A. N. (2024) · Pediatric Cardiology · doi:10.1007/s00246-024-03614-6
- Authors
- Scherr, D., Dalal, D., Henrikson, C. A., Spragg, D. D., Berger, R. D., Calkins, H., & Cheng, A.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Cheng, Alan
- Venue
- Journal of Interventional Cardiac Electrophysiology
- Published
- 2008-04-03
- Volume
- 22
- Issue
- 1
- Pages
- 39-44
- ISSN
- 1383-875X (ISSN-L)
- 1572-8595
- OpenAlex
- W2164883545
- Cited by
- 45
- References
- 12
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 3 · 2019: 6 · 2018: 3 · 2017: 3 · 2016: 1 · 2015: 3 · 2014: 6 · 2013: 4 · 2012: 2
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Interventional Cardiac Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Johns Hopkins University
- Omron Healthcare
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- palpitations, Holter monitoring, event monitors, medication adherence, arrhythmia detection, diagnostic yield
- MeSH terms
- Adult, Aged, Arrhythmias, Cardiac, Equipment Design, Female, Humans, Male, Middle Aged, Patient Compliance, Electrocardiography, Ambulatory, Patient Satisfaction
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
