Heart Palpitations Patient

HEART PALPITATIONS CARDIAC DIAGNOSTICS & MONITORING

Find the answer with cardiac monitoring.

THE CHALLENGE OF HEART PALPITATIONS

  • Palpitations account for 16% of symptoms that prompt patients to visit a general practitioner1
  • It is the second most common complaint for specialist cardiologic evaluation (1st: chest pain)2 
  • Symptom with broad range of causes; usually benign but some are life threatening
  • Generally transitory, patients are often asymptomatic during evaluation
  • Even after extensive testing, it is not always possible to establish a definite cause
  • Frequent and recurrent palpitations can impair a patient's quality of life1
  • The following conditions increase the likelihood of an abnormal heart rhythm:
    • Tachyarrhythmias
    • Structural heart disease
    • Bradyarrhythmias 

SOCIETY RECOMMENDATIONS & GUIDELINES

INSERTABLE CARDIAC MONITORING

EHRA Recommendations3

The European Heart Rhythm Association (EHRA) recommends insertable loop recorders (insertable cardiac monitors) like Reveal LINQ™ ICM for palpitations for the following indications:

  • Increasing monthly in frequency
  • Associated with hemodynamic compromise
  • Other listed examinations prove inconclusive
  • Non-compliant patients without hemodynamic compromise when a clinically significant arrhythmic cause is likely or must be ruled out

EHRA Recommendations Chart


ACC/AHA Ambulatory ECG Guidelines 20004

These guidelines represent some of the current common clinical uses of ambulatory ECG.

For Assessment of Symptoms of Cardiac Arrhythmias

Class Recommended Use

I

  1. Patients with unexplained syncope, near syncope, or episodic dizziness without obvious cause.
  2. Patients with unexplained recurrent palpitation.

IIb

  1. Patients with episodic shortness of breath, chest pain, or fatigue that is not otherwise explained.
  2. Patients with neurologic events when transient atrial fibrillation or flutter is suspected.
  3. Patients with symptoms such as syncope, near syncope, episodic dizziness, or palpitation in whom a probable cause other than an arrhythmia has been identified but in whom symptoms persist despite treatment of this other cause.

Indications for AECG to Assess Symptoms Possibly Related to Rhythm Disturbances

Class Recommended Use

I

  1. Patients with unexplained syncope, near syncope, or episodic dizziness without obvious cause.
  2. Patients with unexplained recurrent palpitation.

IIb

  1. Patients with episodic shortness of breath, chest pain, or fatigue that is not otherwise explained.
  2. Patients with neurologic events when transient atrial fibrillation or flutter is suspected.
  3. Patients with symptoms such as syncope, near syncope, episodic dizziness, or palpitation in whom a probable cause other than an arrhythmia has been identified but in whom symptoms persist despite treatment of this other cause.

EVIDENCE FOR CARDIAC MONITORING

Reveal ICM: Clinical and Cost Effectiveness5

Higher Diagnostic Yield, Lower Cost for Palpitations Diagnosis

Reveal ICM has been shown to be both clinically effective and cost effective when treating palpitations.

Results of the RUP study show:

  • A 73% diagnostic yield for Reveal ICM, compared to a 21% yield for conventional tests
  • Conventional testing arm was 121% more expensive than ICM arm.

Palpitations Rup Study Chart


Ambulatory Cardiac Monitoring6

The diagnosis of cardiac arrhythmias

A prospective multi-center randomized study comparing mobile cardiac outpatient telemetry versus standard event monitoring

Objective

Compare the relative value of MCT vs. event recorder for diagnosing symptoms thought to be related to arrhythmia.

Methods

17-center retrospective analysis of 266 patients with presyncope, syncope, or palpitations with non-diagnostic Holter monitoring who were assigned to either event monitoring or MCT.

Results
  • 88% MCT vs. 75% event recording subjects diagnosed with arrhythmia
  • In a subgroup with either presyncope or syncope, 89% MCT vs. 69% event recording subjects diagnosed
  • MCT was superior in confirming the diagnosis of clinically significant arrhythmias: 41% MCT vs. 15% event recording
Study Conclusions

MCT provides a significantly higher yield than standard event recorders in patients at risk for clinically significant arrhythmias.

Proportion of Patients Diagnosed with Clinically Significant Arrhythmia

All Patients

MCT Syncope Evidence Chart

Syncope/Pre-Syncope Patients

MCT Syncope Evidence Chart

 

Utility of Mobile Cardiac Outpatient Telemetry7

For the diagnosis of palpitations, presyncope, syncope, and the assessment of therapy efficacy

Objective

Evaluate the diagnostic utility of MCT in patients with palpitations and presyncope/syncope and its ability to aid in medication titration on an outpatient basis.

Methods
  • 122 subjects referred for palpitations, presyncope/syncope, or to monitor the efficacy of AA drug therapy wore MCT for 14 days
  • 24-hour transmissions reviewed for any correlation of symptoms to an underlying cardiac arrhythmia
Results
  • 59% of pre-syncope/syncope subjects had a positive diagnosis, with about 50% having a prior negative ECG
  • 19 asymptomatic subjects had an arrhythmia detected
  • 73% of subjects had symptoms correlated to arrhythmias
  • 7 of 21 patients monitored in the outpatient setting had medication adjustments
Study Conclusions

MCT provided a significantly higher diagnosis yield than original ECG, in symptomatic and asymptomatic patients. MCT provided the added benefit of monitoring during medication dose titration.


1

Kroenke K, et al. Ann Intern Med. 2001 May 1;134(9 Pt 1):783-5. Arch Intern Med. 1990 Aug;150(8):1586-7.

2

Mayou RA. Chest pain, palpitations and panic. J Psychosom Res. 1998;44:53—70.

3

Raviele A. et al. Management of patients with palpitations: a position paper from the European Heart Rhythm Association. Europace (2011) 13, 920–934

4

ACC/AHA Guidelines for Ambulatory Electrocardiography: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography). JACC. 1999.

5

Giada F, et al. Recurrent unexplained palpitations (RUP) study comparison of implantable loop recorder versus conventional diagnostic strategy. J Am Coll Cardiol. 2007. 49:19:1951-6.

6

Rothman SA, Laughlin JC, Seltzer J, et al. The diagnosis of cardiac arrhythmias: a prospective multi-center randomized study comparing mobile cardiac outpatient telemetry versus standard loop event monitoring. J Cardiovasc Electrophysiol. March 2007;18(3):241-247.

7

Olson JA, Fouts AM, Padanilam BJ, Prystowsky EN. Utility of mobile cardiac outpatient telemetry for the diagnosis of palpitations, presyncope, syncope and the assessment of therapy efficacy. J Cardiovasc Electrophysiol. May 2007;18(5):473-477.