title: Cardiac event recorders yield more diagnoses and are more cost-effective than 48-hour Holter monitoring in patients with palpitations. A controlled clinical trial.
abstract: OBJECTIVE
  To compare the diagnostic yield and cost-effectiveness of transtelephonic event monitors with those of Holter monitoring in patients with intermittent palpitations.
  
  
  METHODS
  Randomized crossover trial.
  
  
  METHODS
  Diagnostic service of a teaching hospital and surrounding primary care practices.
  
  
  METHODS
  43 patients with previously uninvestigated palpitations who were referred for Holter monitoring.
  
  
  METHODS
  Patients were randomly allocated to receive an event monitor or 48-hour Holter monitor and then to receive the other device. Event monitors were used for 3 months or until two recordings were obtained while symptoms occurred. The main end point was an electrogram recorded during symptoms. The incremental cost-effectiveness of obtaining a diagnostic rhythm strip from event monitors was compared with that of Holter monitoring.
  
  
  RESULTS
  The mean (+/- SD) patient age was 45 +/- 19 years; 37 patients (88%) were women. Event monitors were twice as likely to provide a diagnostic rhythm strip electrocardiogram during symptoms as 48-hour Holter monitoring (29 patients [67%] and 15 patients [35%], respectively; P < 0.001). Event monitors detected 8 patients (19%) with clinically important arrhythmias (6 patients with supraventricular tachycardia and 2 with atrial fibrillation or flutter), whereas the Holter monitors detected no significant arrhythmia (P < 0.005). With the event monitors, most patients transmitted an electrocardiogram recording by 6 weeks. Event monitors were dominant and therefore more cost-effective than 48-hour Holter monitoring, resulting in a cost savings of $213 for each additional diagnostic rhythm strip obtained during symptoms.
  
  
  CONCLUSIONS
  Holter monitoring is a poor diagnostic test for intermittent palpitations. Event recorders provide better data and are more cost-effective.
authors.affiliation: John Hunter Hospital, New South Wales, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Kinlay
authors.forename: J W
authors.initials: JW
authors.lastname: Leitch
authors.forename: A
authors.initials: A
authors.lastname: Neil
authors.forename: B L
authors.initials: BL
authors.lastname: Chapman
authors.forename: D B
authors.initials: DB
authors.lastname: Hardy
authors.forename: P J
authors.initials: PJ
authors.lastname: Fletcher
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000191:economics; D001281:Atrial Fibrillation / Q000175:diagnosis; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D004562:Electrocardiography / Q000191:economics / Q000379:methods*; D015716:Electrocardiography, Ambulatory / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged