Ambulatory Cardiac Monitoring for Discharged Emergency Department Patients with Possible Cardiac Arrhythmias
Open accessAbstract
INTRODUCTION: Many emergency department (ED) patients have symptoms that may be attributed to arrhythmias, necessitating outpatient ambulatory cardiac monitoring. Consensus is lacking on the optimal duration of monitoring. We describe the use of a novel device applied at ED discharge that provides continuous prolonged cardiac monitoring. METHODS: We enrolled discharged adult ED patients with symptoms of possible cardiac arrhythmia. A novel, single use continuous recording patch (Zio®Patch) was applied at ED discharge. Patients wore the device for up to 14 days or until they had symptoms to trigger an event. They then returned the device by mail for interpretation. Significant arrhythmias are defined as: ventricular tachycardia (VT) ≥4 beats, supraventricular tachycardia (SVT) ≥4 beats, atrial fibrillation, ≥3 second pause, 2nd degree Mobitz II, 3rd degree AV Block, or symptomatic bradycardia. RESULTS: There were 174 patients were enrolled and all mailed back their devices. The average age was 52.2 (± 21.0) years, and 55% were female. The most common indications for device placement were palpitations 44.8%, syncope 24.1% and dizziness 6.3%. Eighty-three patients (47.7%) had ≥1 arrhythmias and 17 (9.8%) were symptomatic at the time of their arrhythmia. Median time to first arrhythmia was 1.0 days (IQR 0.2-2.8) and median time to first symptomatic arrhythmia was 1.5 days (IQR 0.4-6.7). 93 (53.4%) of symptomatic patients did not have any arrhythmia during their triggered events. The overall diagnostic yield was 63.2% CONCLUSION: The Zio®Patch cardiac monitoring device can efficiently characterize symptomatic patients without significant arrhythmia and has a higher diagnostic yield for arrhythmias than traditional 24-48 hour Holter monitoring. It allows for longer term monitoring up to 14 days.
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In Schreiber et al., diagnostic yield was 63.2% in detection of atrial fibrillation.
“Schreiber D 26 and colleagues in their study found a diagnostic yield of 63.2% in detection of atrial fibrillation.”
From Portable out-of-hospital electrocardiography: A review of current technologies (2018) · cites this paper as [26]
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Wearable Devices for Ambulatory Cardiac Monitoring
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- Authors
- Schreiber, D., Sattar, A., Drigalla, D., & Higgins, S.
- Affiliations
- Stanford Medicine (US)
- Texas A&M University (US)
- Scripps Memorial Hospital (US)
- Corresponding author
- Schreiber, Donald
- ORCID
- Schreiber, Donald
- Venue
- Western Journal of Emergency Medicine
- Published
- 2014
- Volume
- 15
- Issue
- 2
- Pages
- 194-198
- ISSN
- 1936-900X (ISSN-L)
- 1936-9018
- PMC
- PMC3966438
- OpenAlex
- W2095917950
- Cited by
- 65
- References
- 17
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 1 · 2023: 5 · 2022: 8 · 2021: 5 · 2020: 6 · 2019: 9 · 2018: 6 · 2017: 3 · 2016: 3 · 2015: 4 · 2014: 4
- FWCI
- 3.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Western Journal of Emergency Medicine (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc)
- Funders
- School of Medicine, Stanford University
- Stanford Bio-X
- 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 pacing and defibrillation studies
- Keywords
- ambulatory cardiac monitoring, cardiac arrhythmias, emergency department discharge, prolonged cardiac monitoring, Holter monitoring, ventricular tachycardia, supraventricular tachycardia, atrial fibrillation, bradycardia, syncope, palpitations, diagnostic yield
- MeSH terms
- Arrhythmias, Cardiac, Atrial Fibrillation, Bradycardia, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Patient Discharge, Tachycardia, Supraventricular, Time Factors, Tachycardia, Ventricular, Monitoring, Ambulatory
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