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Recurrent Unexplained Palpitations (RUP) Study
Open accessAbstract
Objectives The aim of the study was to compare the diagnostic yield and the costs of implantable loop recorder (ILR) with those of the conventional strategy in patients with unexplained palpitations.Background In patients with unexplained palpitations, especially in those with infrequent symptoms, the conventional strategy, including short-term ambulatory electrocardiogram (ECG) monitoring and electrophysiological study, sometimes fails to establish a diagnosis.Methods We studied 50 patients with infrequent (< or =1 episode/month), sustained (>1 min) palpitations. Before enrollment, patients had a negative initial evaluation, including history, physical examination, and ECG. Patients were randomized either to conventional strategy (24-h Holter recording, a 4-week period of ambulatory ECG monitoring with an external recorder, and electrophysiological study) (n = 24) or to ILR implantation with 1-year monitoring (n = 26). Hospital costs of the 2 strategies were calculated.Results A diagnosis was obtained in 5 patients in the conventional strategy group, and in 19 subjects in the ILR group (21% vs. 73%, p < 0.001). Despite the higher initial cost, the cost per diagnosis in the ILR group was lower than in the conventional strategy group (euro 3,056 +/- euro 363 vs. euro 6,768 +/- euro 6,672, p = 0.012).Conclusions In subjects without severe heart disease and with infrequent palpitations, ILR is a safe and more cost-effective diagnostic approach than conventional strategy.
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“Moreover, clinical characteristics of the patient, such as age, presence of heart disease, and ECG abnormalities, do not always allow the physician to identify a priori those cases in which palpitations are caused by clinically significant rhythm disorders.8,47,48,52 -54”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [52]
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“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 [52]
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Metadata
- Authors
- Giada, F., Gulizia, M., Francese, M., Croci, F., Santangelo, L., Santomauro, M., Occhetta, E., Menozzi, C., & Raviele, A.
- Affiliations
- Federico II University Hospital (IT)
- Azienda Ospedaliero Universitaria Maggiore della Carita (IT)
- Corresponding author
- Raviele, Antonio
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2007-05
- Volume
- 49
- Issue
- 19
- Pages
- 1951-1956
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W70889386
- Cited by
- 158
- References
- 9
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 2 · 2023: 9 · 2022: 9 · 2021: 15 · 2020: 6 · 2019: 7 · 2018: 16 · 2017: 11 · 2016: 7 · 2015: 10 · 2014: 11 · 2013: 13 · 2012: 5
- FWCI
- 5.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Funders
- Medtronic
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- implantable loop recorder, diagnostic yield, cost-effectiveness, Holter monitoring, electrophysiological study, arrhythmia diagnosis
- MeSH terms
- Adult, Aged, Arrhythmias, Cardiac, Cost-Benefit Analysis, Electrodes, Implanted, Female, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Sensitivity and Specificity, Time Factors, Electrocardiography, Ambulatory
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