Infrequent Palpitations Research Articles

A NEW DIGITAL SOLUTION TO UNLOCK THE POTENTIAL OF SMART WEARABLES FOR REMOTE PATIENT CARDIAC MONITORING

BackgroundWearable devices have the potential to transform the traditional care pathway by enabling a much closer follow-up of patients' condition. However, they create an overwhelming amount of data not integrated in the clinical workflow. This prevents the technology from making its way into clinical practice on a large scale.NarrativeNinety patients were monitored using Cardiologs RPM, a solution that automatically collects and consolidates ECG and Photoplethysmography Heart Rate data (PPG-HR) from patient-owned smartwatches.From a workflow standpoint, data was centralized and triaged automatically, helping physicians to quickly access and review information of interest.From a clinical standpoint, the technology supported both the diagnosis and monitoring of patients as illustrated with these clinical cases:- A 25-year-old female was suffering from infrequent palpitations of unknown origin for years. Continuous PPG-HR data consolidated with ECGs recorded while she was symptomatic demonstrated supraventricular tachyarrhythmia. She got an ablation and has not experienced any palpitations since then.- A 60-year-old male with atrial flutter had recurrences detected on the ECGs he recorded with his smartwatch. Physicians were able to adjust the dosage of the anti-arrhythmic drug remotely rather than referring him to the emergency room because they were monitoring how he responded to the treatment.From the patient's point of view, they can use the device they own and are used to, in the comfort of their own home. They are reassured that their heart data is shared with their doctor.ConclusionCardiac data from the smartwatch showing paroxysmal supraventricular tachycardia. ECG (a) and heart rate plot consolidating ECG and PPG data acquired in the background (b).View Large Image Figure ViewerDownload Hi-res image Download (PPT) BackgroundWearable devices have the potential to transform the traditional care pathway by enabling a much closer follow-up of patients' condition. However, they create an overwhelming amount of data not integrated in the clinical workflow. This prevents the technology from making its way into clinical practice on a large scale. Wearable devices have the potential to transform the traditional care pathway by enabling a much closer follow-up of patients' condition. However, they create an overwhelming amount of data not integrated in the clinical workflow. This prevents the technology from making its way into clinical practice on a large scale. NarrativeNinety patients were monitored using Cardiologs RPM, a solution that automatically collects and consolidates ECG and Photoplethysmography Heart Rate data (PPG-HR) from patient-owned smartwatches.From a workflow standpoint, data was centralized and triaged automatically, helping physicians to quickly access and review information of interest.From a clinical standpoint, the technology supported both the diagnosis and monitoring of patients as illustrated with these clinical cases:- A 25-year-old female was suffering from infrequent palpitations of unknown origin for years. Continuous PPG-HR data consolidated with ECGs recorded while she was symptomatic demonstrated supraventricular tachyarrhythmia. She got an ablation and has not experienced any palpitations since then.- A 60-year-old male with atrial flutter had recurrences detected on the ECGs he recorded with his smartwatch. Physicians were able to adjust the dosage of the anti-arrhythmic drug remotely rather than referring him to the emergency room because they were monitoring how he responded to the treatment.From the patient's point of view, they can use the device they own and are used to, in the comfort of their own home. They are reassured that their heart data is shared with their doctor. Ninety patients were monitored using Cardiologs RPM, a solution that automatically collects and consolidates ECG and Photoplethysmography Heart Rate data (PPG-HR) from patient-owned smartwatches. From a workflow standpoint, data was centralized and triaged automatically, helping physicians to quickly access and review information of interest. From a clinical standpoint, the technology supported both the diagnosis and monitoring of patients as illustrated with these clinical cases: - A 25-year-old female was suffering from infrequent palpitations of unknown origin for years. Continuous PPG-HR data consolidated with ECGs recorded while she was symptomatic demonstrated supraventricular tachyarrhythmia. She got an ablation and has not experienced any palpitations since then. - A 60-year-old male with atrial flutter had recurrences detected on the ECGs he recorded with his smartwatch. Physicians were able to adjust the dosage of the anti-arrhythmic drug remotely rather than referring him to the emergency room because they were monitoring how he responded to the treatment. From the patient's point of view, they can use the device they own and are used to, in the comfort of their own home. They are reassured that their heart data is shared with their doctor. Conclusion

INFREQUENT PALPITATIONS: BENIGN, OR A SIGN OF SOMETHING OMINOUS?

INFREQUENT PALPITATIONS: BENIGN, OR A SIGN OF SOMETHING OMINOUS?

A single center experience on the clinical utility evaluation of an insertable cardiac monitor

BackgroundThe evaluation of insertable cardiac monitor (ICM) has been largely on the device performance and safety with only limited studies on the clinical utility. The aim of this study was to evaluate the clinical utility of ICM in patients with a variety of clinical presentations. MethodsA single-center retrospective study on the clinical utility, as measured by both expected and unexpected clinical useful ICM findings and the initiation of therapeutic interventions, was conducted. ResultsNinety-five consecutive patients (median age 68 years) received ICM Reveal LINQ™ for clinical indications of unexplained syncope (53), cryptogenic stroke (19), unexplained infrequent palpitations (14) and AF management (9). During a median follow-up of 414 days, the causes for unexplained syncope were arrhythmia-related (11.3%), arrhythmia-unrelated (32%) and undetermined (56.6%). Atrial fibrillation in patients with cryptogenic stroke was detected in 31.6% (6/19). The clinical utility occurrence was 48.4% with the expected and incidental (unexpected) clinical utility of 41% and 7.4% patients respectively. Of these, therapeutic interventions based on ICM diagnoses were initiated in 18.9% (18/95) of patients. ConclusionsICM (Reveal LINQ™) offers substantial expected and unexpected clinical utility in patients with a variety of clinical presentations. The causes of nearly one third of patients receiving ICM for unexplained syncope were unrelated to cardiac arrhythmia. Nearly one fifth of patients with newly diagnosed arrhythmia from ICM received therapeutic interventions.

Use of a Patient-activated Event Recording System in a Patient with Infrequent Palpitations

Holter monitoring is usually limited to a 24-hour period. However, this duration may be inadequate in cases where palpitations are infrequent. A 17-year-old male patient with infrequent paroxysmal palpitations was diagnosed with paroxysmal supraventricular tachycardia after he was monitored with a patient-activated event recording system. We observed that this device can provide useful diagnostic information in the outpatient clinical setting.

A 38-Year-Old Man With Obesity, Intermittent Tachycardia, and One Episode of Syncope

A 38-year-old man with history of diabetes, hypertension, hyperlipidemia, and obesity was referred to the electrophysiology clinic for evaluation of infrequent palpitations and remote history of syncope. The patient described a sensation of racing of the heart, which lasted about 30 min to 1 h and occurred several times over the past year. This was associated with a sense of anxiety and shortness of breath and appeared to resolve spontaneously. The patient also experienced one episode of syncope in the past while enjoying a barbecue on a hot summer day. He did not recall if this episode was accompanied by palpitations, however, the previously mentioned symptoms prompted the consultation. Upon further questioning the patient also reported experiencing fatigue. He stated that he noted decreased energy and frequent daytime sleepiness.

Utility of wireless ECG event recording system in children

AimEvent recorders have been widely used for diagnosis of cardiac rhythm disorders in patients who describe infrequent symptoms, which may be attributed to arrhythmias. These systems may helpful in patients with negative conventional cardiac tests such as ECG, Holter monitoring and exercise test. We reported our results with wireless event recording in a small patient group. MethodsMedical records of eight children who suffered from infrequent palpitations with negative tests, received V-patch event recording system between August 2011 and March 2012 were reviewed retrospectively. The mean age of the patients was 10.7. Two patients had undergone invasive electrophysiological study and had normal results. ResultsTwo patients removed from study, remaining six patients were followed for 23.3 ± 6.59 days. Two patients showed narrow QRS complex tachycardia in the first week and antiarrhythmic drug therapy was initiated. In one of them with narrow QRS tachycardia previous EPS was negative. Four patients showed physiologic sinus tachycardia during symptoms and referred to other clinics or discharged from cardiology follow-up. ConclusionV-patch wireless event recorder system might be a more preferable method in patients with arrhythmia symptoms and negative noninvasive tests.

Event-Rekorder

Event or loop recorders monitor heart rhythm using discontinuous ECG storage which enables them to obtain a correlation between symptoms and the underlying heart rhythm in patients with infrequent, short-lasting episodes. External event recorders with intermittent monitoring, i.e., with electrodes within the device, are suitable for patients with palpitations or tachycardia who remain conscious. External event recorders with continuous monitoring are tolerated by patients for a few weeks and have a limited diagnostic impact in patients with recurrent syncope. The implantable loop recorder (ILR) monitors heart rhythm for one year and after patient-triggered or automatic activation stores a one-lead ECG up to 42 minutes prior to device activation. The diagnostic benefit of ILR in comparison to conventional approaches has been demonstrated in randomised studies. Furthermore, an ILR identifies patients with recurrent syncope of unknown origin in whom a pacemaker implantation can avoid further episodes. Additional possible indications are the monitoring of atrial fibrillation, the diagnostics of infrequent palpitations and patients with seizures.

Recurrent Unexplained Palpitations (RUP) Study: Comparison of Implantable Loop Recorder Versus Conventional Diagnostic Strategy

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. 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. 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. 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). In subjects without severe heart disease and with infrequent palpitations, ILR is a safe and more cost-effective diagnostic approach than conventional strategy.

A34-2 IS the diagnostic yield of 24-hour holter monitoring different between patients with frequent vs. infrequent palpitations?

A34-2 IS the diagnostic yield of 24-hour holter monitoring different between patients with frequent vs. infrequent palpitations?

A34-2 Is the diagnostic yield of 24-hour Holter monitoring different between patients with frequent vs. infrequent palpitations?

A34-2 Is the diagnostic yield of 24-hour Holter monitoring different between patients with frequent vs. infrequent palpitations?