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The Diagnosis of Cardiac Arrhythmias: A Prospective Multi‐Center Randomized Study Comparing Mobile Cardiac Outpatient Telemetry Versus Standard Loop Event Monitoring
Author(s) -
ROTHMAN STEVEN A.,
LAUGHLIN JAMES C.,
SELTZER JONATHAN,
WALIA JASJIT S.,
BAMAN RAKESH I.,
SIOUFFI SAMER Y.,
SANGRIGOLI ROBERT M.,
KOWEY PETER R.
Publication year - 2007
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2006.00729.x
Subject(s) - medicine , presyncope , palpitations , ambulatory , randomized controlled trial , cardiology , implantable loop recorder , cardiac monitoring , prospective cohort study , sudden cardiac death , clinical endpoint , electrocardiography , heart rate , atrial fibrillation , blood pressure
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.