The Diagnosis of Cardiac Arrhythmias: A Prospective Multi-Center Randomized Study Comparing Mobile Cardiac Outpatient Telemetry Versus Standard Loop Event Monitoring

• Published in: Journal of cardiovascular electrophysiology Vol. 18; no. 3; pp. 241 - 247
• Main Authors: ROTHMAN, STEVEN A., LAUGHLIN, JAMES C., SELTZER, JONATHAN, WALIA, JASJIT S., BAMAN, RAKESH I., SIOUFFI, SAMER Y., SANGRIGOLI, ROBERT M., KOWEY, PETER R.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.03.2007
• Subjects: Ambulatory Care - methods; arrhythmia; Arrhythmias, Cardiac - complications; Arrhythmias, Cardiac - diagnosis; Cohort Studies; Electrocardiography, Ambulatory - instrumentation; Electrocardiography, Ambulatory - methods; Equipment Design; event monitor; Female; Humans; loop recorder; Male; Middle Aged; palpitations; Prospective Studies; Sensitivity and Specificity; syncope; Syncope - etiology; Telemetry - instrumentation
• ISSN: 1045-3873; 1540-8167; 1540-8167
• DOI: 10.1111/j.1540-8167.2006.00729.x

Introduction: Ambulatory electrocardiographic monitoring systems are frequently used in the outpatient evaluation of symptoms suggestive of a cardiac arrhythmia; however, they have a low yield in the identification of clinically significant but infrequent, brief, and/or intermittently symptomatic arrhythmias. The purpose of this study was to compare the relative value of a mobile cardiac outpatient telemetry system (MCOT) with a patient‐activated external looping event monitor (LOOP) for symptoms thought to be due to an arrhythmia. Methods and Results: The study was a 17‐center prospective clinical trial with patients randomized to either LOOP or MCOT for up to 30 days. Subjects with symptoms of syncope, presyncope, or severe palpitations who had a nondiagnostic 24‐hour Holter monitor were randomized. The primary endpoint was the confirmation or exclusion of a probable arrhythmic cause of their symptoms. A total of 266 patients who completed the monitoring period were analyzed. A diagnosis was made in 88% of MCOT subjects compared with 75% of LOOP subjects (P = 0.008). In a subgroup of patients presenting with syncope or presyncope, a diagnosis was made in 89% of MCOT subjects versus 69% of LOOP subjects (P = 0.008). MCOT was superior in confirming the diagnosis of clinical significant arrhythmias, detecting such events in 55 of 134 patients (41%) compared with 19 of 132 patients (15%) in the LOOP group (P < 0.001). Conclusions: MCOT provided a significantly higher yield than standard cardiac loop recorders in patients with symptoms suggestive of a significant cardiac arrhythmia.