Evaluation of Patients with Palpitations: Cardiac Event Recorder Versus 48-hour Holter Monitoring

Abstract

Objectives: (1) To compare a diagnostic yield of cardiac event recorders with that of 48-hour Holler monitoring, (2) to determine the etiologies of palpitations, and (3) to assess an optimal duration of using an event recorder by a patient. Background: Palpitation is a common symptom which accounts for 16% of total complaints reported by patients in general medical settings. An ambulatory Holter ECG monitoring or an event recorder can be used to establish the cause of palpitations. Methods: (1)The study group consisted of 33 consecutive patients (24 females, 9 males, mean age 50 ± 32 years) with undiagnosed attacks of palpitations, occurring at least once per month. Each patient was randomly allocated to use either an event monitor or 48-hour Holler monitoring. The patient kept the event monitor for 4 weeks. After the first monitor was returned, the patient was given the other device. Results: Holter monitoring determined the etiology of palpitations in 11 (33%) patients, and the event recorder in 21 (64%) patients (P = 0.0138). In the whole study group, the etiology of palpitations was disclosed in 23 (70%) patients. The diagnosis was possible using Holler ECG monitoring in only 2 (9%) patients, whereas the event recorder revealed the underlying mechanism of palpitations in 12 (52%) patients (P = 0.0007). In nine (39%) patients both methods were able to disclose the eliology of palpitations. The findings of 117 recordings obtained using an event recorder during palpitations were atrial fibrillation in 10 (9%), narrow QRS tachycardia in 4 (3%), frequent supraventricular eclopy in 17 (15%), frequent ventricular eclopy in 6 (5%), and episodes of palpitations sinus rhythm were recorded in the remaining 80 (68%). Of patients who experienced episodes of palpitations while using an event recorder, the earliest recording was obtained on the first day of the study, and the latest on the 18 day of using the event recorder. Conclusions: (1) The cardiac event recorders yield more diagnoses than 48-hour Holter monitoring in patients with palpitations occurring at least once per month, (2) in this group of patients the event recorder provided a diagnostic ECG recording during the first 18 days of using the device, and (3) in the majority (57%) of patients a normal sinus rhythm was recorded during episodes of palpitations. A.N.E. 2000;5(4):315–321