Cardiac event recording yields more diagnoses than 24-hour Holter monitoring in patients with palpitations
Abstract
Palpitation is a common symptom that sometimes results from a substantial cardiac arrhythmia. We compared the diagnostic yield of trans-telephonic event monitors with those of Holter monitoring in patients with intermittent palpitations. In all, 310 patients were randomly assigned to receive an event recorder or 24-hour Holter monitoring. Event recorders were used for seven days or until two recordings were obtained while symptoms occurred. The main end-point was an electrocardiogram (ECG) recorded during symptoms. The patients with palpitation recorded the one-lead ECG trace and sent it to a telemedicine call centre, where a nurse responded. There were 119 symptomatic patients in the event recorder group and 74 in the Holter group. The total costs were 6019 for event recording and 9605 for Holter monitoring. The average costs were 51 per symptomatic patient detected by event recorder monitoring and 130 per symptomatic patient detected by Holter monitoring. More patients therefore received a clear diagnosis, and more quickly, when using event recording than with Holter monitoring. For this reason, event recorders are preferable to Holter monitors for patients with palpitations.
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?
External and implantable loop recorders, mobile cardiac outpatient telemetry, and pacemakers and ICDs provide a significantly higher yield than standard patient-activated loop recorders in patients with infrequent palpitations.
“and provide a significantly higher yield than standard patient-activated loop recorders in patients with infrequent palpitations.49,73 -79”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [77]
External and implantable loop recorders, mobile cardiac outpatient telemetry, and pacemakers and ICDs can detect asymptomatic clinically significant arrhythmias automatically, without patient activation.
“The external and implantable loop recorders, mobile cardiac outpatient telemetry, and pacemakers and ICDs can detect asymptomatic clinically significant arrhythmias automatically (i.e. with no activation by the patient)”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [77]
Cites
The Prevalence of Symptoms in Medical Outpatients and the Adequacy of Therapy
Arrington, M. E. (1990) · Archives of Internal Medicine · doi:10.1001/archinte.1990.00040031685016 · Cited by 367 · see citing works
Use 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
The 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
Evaluation of outpatient arrhythmias utilizing transtelephonic monitoring
Judson, P. L., Holmes, D. R., & Baker, W. P. (1979) · American Heart Journal · doi:10.1016/0002-8703(79)90011-5 · Cited by 35 · see citing works
Transtelephonic electrocardiographic monitoring for detection and treatment of cardiac arrhythmia
Safe, A. F., & Maxwell, R. T. (1990) · Postgraduate Medical Journal · doi:10.1136/pgmj.66.772.110 · Cited by 12 · see citing works
Detection of arrhythmia: limited usefulness of patient activated recording devices.
Thomas, L., Shapiro, L. M., Perrins, E. J., & Fox, K. M. (1984) · BMJ · doi:10.1136/bmj.289.6452.1106 · Cited by 9 · see citing works
Can patients discriminate between atrial fibrillation and regular supraventricular tachycardia?
Leitch, J. W., Klein, G. J., & Yee, R. (1991) · The American Journal of Cardiology · doi:10.1016/0002-9149(91)90420-p · Cited by 5 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Determinants of successful telemedicine implementations: a literature study
Broens, T. H. F., Huis in't Veld, R. M. H. A., Vollenbroek-Hutten, M. M. R., Hermens, H. J., van Halteren, A. T., & Nieuwenhuis, L. J. M. (2007) · Journal of Telemedicine and Telecare · doi:10.1258/135763307781644951 · Cited by 466 · see citing works
Remote Patient Monitoring via Non-Invasive Digital Technologies: A Systematic Review
Vegesna, A., Tran, M., Angelaccio, M., & Arcona, S. (2017) · Telemedicine and e-Health · doi:10.1089/tmj.2016.0051 · Cited by 404 · see citing works
Noah, B., Keller, M. S., Mosadeghi, S., Stein, L., Johl, S., Delshad, S., Tashjian, V. C., Lew, D., Kwan, J. T., Jusufagic, A., et al. (2018) · npj Digital Medicine · doi:10.1038/s41746-017-0002-4 · Cited by 273 · 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
Does this patient with palpitations have a cardiac arrhythmia?
Thavendiranathan, P. (2009) · JAMA · doi:10.1001/jama.2009.1673 · Cited by 75 · see citing works
Efficacy of diagnostic tools for detecting cardiac arrhythmias: systematic literature search
Hoefman, E., Bindels, P., & van Weert, H. C. P. M. (2010) · Netherlands Heart Journal · doi:10.1007/s12471-010-0831-0 · Cited by 50 · see citing works
Polhemus, A. M., Novák, J. M., Ferrão, J. C., Simblett, S. K., Radaelli, M., Locatelli, P., Matcham, F., Kerz, M., Weyer, J., Burke, P., et al. (2020) · JMIR mhealth and uhealth · doi:10.2196/16043 · Cited by 40 · see citing works
Sulfi, S., Balami, D., Sekhri, N., Suliman, A., Kapur, A., Archbold, A., Ranjadayalan, K., & Timmis, A. (2008) · Annals of Noninvasive Electrocardiology · doi:10.1111/j.1542-474x.2007.00199.x · Cited by 25 · see citing works
Comparison between a 6‑lead smartphone ECG and 12‑lead ECG in athletes
Orchard, J. J., Orchard, J. W., Raju, H., Gerche, A. L., Puranik, R., & Semsarian, C. (2021) · Journal of Electrocardiology · doi:10.1016/j.jelectrocard.2021.03.008 · Cited by 23 · see citing works
Sharma, A. N., & Baranchuk, A. M. (2021) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2021.04.003 · Cited by 20 · see citing works
A Business Model Analysis of Telecardiology Service
Lin, S.-H., Liu, J., Wei, J., Yin, W., Chen, H., & Chiu, W. (2010) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2010.0059 · Cited by 19 · see citing works
Sparkes, J., Valaitis, R. K., & McKibbon, A. (2012) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2011.0230 · Cited by 19 · see citing works
Pereira-Monteiro, J. M., Wysocka-Bakowska, M. M., Katsarava, Z., & Antonaci, F. (2010) · The Journal of Headache and Pain · doi:10.1007/s10194-010-0211-6 · Cited by 18 · 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
ANCZYKOWSKI, J., Willems, S., Hoffmann, B. A., Meinertz, T., Blankenberg, S., & Patten, M. (2016) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.13025 · Cited by 12 · see citing works
Frequency of Serious Arrhythmias Detected With Ambulatory Cardiac Telemetry
Kadish, A. H., Reiffel, J. A., Clauser, J., Prater, S. P., Menard, M., & Kopelman, H. A. (2010) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2009.12.047 · Cited by 10 · see citing works
Innovations in telemedicine for cardiovascular care
Brunetti, N. D., Scalvini, S., & Molinari, G. (2016) · Expert Review of Cardiovascular Therapy · doi:10.1586/14779072.2016.1140572 · Cited by 6 · see citing works
Self-citationEmergency Management of Palpitations in the Elderly
Jamshed, N., Dubin, J. S., & ELDADAH, Z. A. (2012) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2012.10.003 · Cited by 6 · see citing works
Diagnostic yield of external loop recording in patients with acute ischemic stroke or TIA
Plas, G. J. J., Bos, J., Velthuis, B. O., SCHOLTEN, M. F., den Hertog, H. M., & Brouwers, P. J. A. M. (2015) · Journal of Neurology · doi:10.1007/s00415-014-7621-3 · Cited by 5 · see citing works
Relative utility of portable ECG devices in capturing arrhythmias in athletes
Davis, A. J., Driscoll, T., Orchard, J. W., Raju, H., Gray, B. R., & Orchard, J. J. (2024) · Expert Review of Medical Devices · doi:10.1080/17434440.2024.2438313 · Cited by 3 · see citing works
Stahlman, J. E., Alghamdi, K., Salmun, L. M., Borras, I. M., Bailey, E., & Schneider, L. C. (2006) · Pediatric Asthma Allergy & Immunology · doi:10.1089/pai.2006.19.118 · Cited by 3 · see citing works
e-Health/m-Health Applications for Cardiac Patients Telemonitoring
Kirtava, Z., Gegenava, T., Gegenava, M., Simonia, G., & Andronikashvili, I. (2015) · World Congress on Medical Physics and Biomedical Engineering, September 7 - 12, 2009, Munich, Germany · doi:10.1007/978-3-319-13117-7_210 · Cited by 3 · 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
Oeff, M., Müller, A., Neuzner, J., Sack, S., SCHWAB, J. O., Pfeiffer, D., & Zugck, C. (2008) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-008-0012-7 · Cited by 3 · see citing works
Davis, A. J., Orchard, J. W., McGhie, D., Broadbridge, D., Raju, H., Gerche, A. L., Puranik, R., Gray, B. R., Jongh, J. D., Driscoll, T., et al. (2024) · Expert Review of Medical Devices · doi:10.1080/17434440.2024.2443113 · Cited by 2 · see citing works
Dasgupta, S., Kelleman, M. S., & Sachdeva, R. (2020) · Pediatric Quality and Safety · doi:10.1097/pq9.0000000000000364 · Cited by 2 · see citing works
Senga, M., Fujii, E., Sugiura, S., Yamazato, S., Nakamura, M., & Ito, M. (2009) · Journal of Arrhythmia · doi:10.1016/s1880-4276(09)80011-2 · Cited by 2 · see citing works
Utility and problems of the cardiac loop event recorder
Tatsuta, A., Yamada, T., Obara, Y., Ichikawa, A., Hayashi, T., Kawashima, M., & Hagiwara, N. (2009) · Japanese Journal of Electrocardiology · doi:10.5105/jse.29.141 · Cited by 2 · see citing works
Chiang, L.-K. (2017) · Journal of Family Medicine and Health Care · doi:10.11648/j.jfmhc.20170301.13 · Cited by 1 · see citing works
Srivatsav, A., Thompson, Z., Bruno, M. A., Stephens, S. B., Gutierrez, M. E., Miyake, C. Y., Morris, S. A., Pham, T. D., Valdés, S. O., Kim, J. J., et al. (2024) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.15087 · Cited by 1 · see citing works
Çınar, B., Kafalı, H. C., Şahin, G. T., & Ergül, Y. (2025) · Cardiology in the Young · doi:10.1017/s1047951125100826 · Cited by 1 · see citing works
イベントレコーダー(携帯型発作時心電図計)により不安定狭心症の診断にいたった1症例
淳, 鈴., 一寛, 清., 森絵里香, 恵, 杉., 剛史, 小., 黒須, 巧., 平野, 圭., 啓二郎, 中., 野池, 博., & 東丸, 貴. (2009) · 心臓 · doi:10.11281/shinzo.41.1347
Lewalter, T. (2008) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-008-0018-1
Telecardiology Tools and Devices
Müller, A., SCHWAB, J. O., Zugck, C., Schweizer, J., & Helms, T. M. (2018) · CRC Press eBooks · doi:10.1201/9781351229067-21
A ten years experience of the "Fondazione Maugeri" network for cardiovascular diseases
Scalvini, S., Giordano, A., & Glisenti, F. (2007)
Self-citationChirurgie bei tachykarden Rhythmusstörungen und Herzschrittmachertherapie
Scheid, H. H., & Gulbins, H. (2010) · Springer eBooks · doi:10.1007/978-3-540-79713-5_26
Telecardiology Tools and Devices
Müller, A., SCHWAB, J. O., Zugck, C., Schweizer, J., & Helms, T. M. (2015) · CRC Press eBooks · doi:10.1201/b19210-26
Pines, J. M., Carpenter, C. R., Raja, A. S., & Schuur, J. D. (2012) · Wiley eBooks · doi:10.1002/9781118482117.ch24
Ambulatory Electrocardiography
Rho, R. W., & Page, R. L. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4377-0285-9.00071-5
Probst, M. A., & Carpenter, C. R. (2023) · Wiley eBooks · doi:10.1002/9781119616870.ch22
Miller, C., Sharari, R., Ali, M. M., Omana, J., Milutinovic, M., & Dusic, A. (2023) · Open Journal of Internal Medicine · doi:10.4236/ojim.2023.133024
Homme, J. L., Kranz, L. A., House, M., & Greenmyer, J. R. (2025) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2025.04.012
Utility of wireless ECG event recording system in children
Çongur, E. Ç., Şahin, M., Yilancioğlu, Ş. K., & Çeliker, A. (2015) · Journal of Indian College of Cardiology · doi:10.1016/j.jicc.2015.05.003
- Authors
- Scalvini, S., Zanelli, E., Martinelli, G., Baratti, D., Giordano, A., & Glisenti, F.
- Affiliations
- Cardiology Division, S Maugeri Foundation, IRCCS, Gussago, Brescia
- Health Telematic Network S.p.A., Brescia, Italy
- Corresponding author
- Scalvini, S
- Venue
- Journal of Telemedicine and Telecare
- Publisher
- SAGE Publications
- Published
- 2005-07
- Volume
- 11
- Issue
- 1_suppl
- Pages
- 14-16
- ISSN
- 1357-633X (ISSN-L)
- 1758-1109
- OpenAlex
- W1974503807
- Cited by
- 45
- References
- 7
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 2 · 2021: 3 · 2020: 2 · 2018: 1 · 2017: 2 · 2016: 3 · 2015: 4 · 2014: 1 · 2012: 4
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Telemedicine and Telecare (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eidgenössische Technische Hochschule Zürich
- 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
- 24-hour Holter monitoring, palpitations, cardiac arrhythmias, telemedicine, event monitors, diagnostic yield, cost comparison
- MeSH terms
- Arrhythmias, Cardiac, Female, Heart, Humans, Male, Middle Aged, Telephone, Electrocardiography, Ambulatory, Health Care Costs, Telemedicine, Monitoring, Ambulatory
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