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Cardiac Event Recorders Yield More Diagnoses and Are More Cost-effective than 48-Hour Holter Monitoring in Patients with Palpitations: A Controlled Clinical Trial
Abstract
OBJECTIVE: To compare the diagnostic yield and cost-effectiveness of transtelephonic event monitors with those of Holter monitoring in patients with intermittent palpitations. DESIGN: Randomized crossover trial. SETTING: Diagnostic service of a teaching hospital and surrounding primary care practices. PATIENTS: 43 patients with previously uninvestigated palpitations who were referred for Holter monitoring. MEASUREMENTS: 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. RESULTS: 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. CONCLUSIONS: Holter monitoring is a poor diagnostic test for intermittent palpitations. Event recorders provide better data and are more cost-effective.
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In the citing paper
“Whereas these recorders can be useful in the investigation of palpitations, 163 they have a marginal role in the evaluation of syncope.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [163]
In the citing paper
“Recent studies have shown that patient-triggered cardiac event recorders (CER) have an increased diagnostic yield and are more cost effective than conventional 24h-Holter electrocardiograms (ECGs) for the evaluation of sporadic, potentially arrhythmia-related symptoms.”
In the citing paper
“Recent studies have shown that patient-triggered cardiac event recorders (CER) have an increased diagnostic yield and are more cost effective than conventional 24h-Holter electrocardiograms (ECGs) for the evaluation of sporadic, potentially arrhythmia-related symptoms.”
In the citing paper
“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 [76]
In the citing paper
“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 [76]
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“…skin-attached patches allows the detection of intermittent arrhythmias such as tachycardia, bradycardia, premature beats, and pauses, clinical studies have demonstrated that the median time to the first arrhythmic event is 3–4 days, exceeding the detection window of standard Holter monitoring [62].”
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Metadata
- Authors
- Kinlay, S., Leitch, J. W., Neil, A., Chapman, B. L., Hardy, D. B., & Fletcher, P. J.
- Affiliations
- John Hunter Hospital (AU)
- Corresponding author
- Kinlay, Scott
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1996-01-01
- Volume
- 124
- Issue
- 1_Part_1
- Pages
- 16-20
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2028013985
- Cited by
- 245
- References
- 0
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 3 · 2023: 5 · 2022: 2 · 2021: 9 · 2020: 7 · 2019: 4 · 2018: 9 · 2017: 7 · 2016: 6 · 2015: 9 · 2014: 9 · 2013: 14 · 2012: 8
- FWCI
- 6.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- Holter monitoring, cost-effectiveness, diagnostic yield, supraventricular tachycardia, atrial fibrillation, arrhythmia detection, transtelephonic monitoring, electrocardiogram
- MeSH terms
- Adult, Arrhythmias, Cardiac, Atrial Fibrillation, Cost-Benefit Analysis, Electrocardiography, Female, Humans, Male, Middle Aged, Electrocardiography, Ambulatory, Cross-Over Studies
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