The diagnosis of cardiac arrhythmias: a prospective multi-center randomized study comparing mobile cardiac outpatient telemetry versus standard loop event monitoring.
BACKGROUND
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.


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.
Rothman
Steven A
SA
Lankenau Hospital and Institute for Medical Research/Main Line Health Heart Center, Wynnewood, PA, USA. rothmans@casep.com
Laughlin
James C
JC
Seltzer
Jonathan
J
Walia
Jasjit S
JS
Baman
Rakesh I
RI
Siouffi
Samer Y
SY
Sangrigoli
Robert M
RM
Kowey
Peter R
PR
D000553:Ambulatory Care / Q000379:methods*; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis*; D015331:Cohort Studies; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013575:Syncope / Q000209:etiology; D013686:Telemetry / Q000295:instrumentation*