Diagnostic yield of automatic and patient‐triggered ambulatory cardiac event recording in the evaluation of patients with palpitations, dizziness, or syncope

Background : Recent studies have shown that patient‐triggered cardiac event recorders (CER) have an increased diagnostic yield and are more cost effective than conventional 24‐h‐Holter electrocardiograms (ECGs) for the evaluation of sporadic, potentially arrhythmia‐related symptoms. Hypothesis : The aim of this study was to determine the diagnostic yield of a patient‐triggered CER combined with continuous automatic arrhythmia detection in the evaluation of sporadic dizziness/syncope or palpitations and its clinical relevance in assessing the further management. Methods : We investigated 101 consecutive outpatients (54 ± 20 years, 40 women), referred for evaluation of sporadic dizziness and syncope (36%) or palpitations (64%) of suspected rhythmogenic origin. All were monitored by patient‐triggered CER with continuous automatic arrhythmia detection. Results : After a mean monitoring period of 103 ± 38 h, 83 patients registered symptoms and 57 patients had diagnostic or therapeutic relevant arrhythmias (relA). A total of 196 episodes of relA were recorded; 31 (16%) episodes were patient‐triggered and 165 (84%) automatically recorded. Diagnostic relevant episodes (relA and/or typical symptoms) occurred in 94 patients, in 54% after the first 24 h of monitoring. According to the results of the CER, 80 patients needed no further diagnostic evaluation; 20 had additional diagnostic tests. Conclusions : Cardiac event recorders with a continuous automatic arrhythmia detection function are a well‐tolerated device for sporadic, potentially arrhythmia‐related symptoms. The patient‐triggered mode alone is not sufficiently reliable; the automatic continuous arrhythmia detection function has additional diagnostic and therapeutic consequences. In 54% of all patients, the first diagnostic event would not have been recorded with a single conventional 24‐h‐Holter ECG.