title: Ambulatory cardiac monitoring for discharged emergency department patients with possible cardiac arrhythmias.
abstract: BACKGROUND
  Many emergency department (ED) patients have symptoms that may be attributed to arrhythmias, necessitating outpatient ambulatory cardiac monitoring. Consensus is lacking on the optimal duration of monitoring. We describe the use of a novel device applied at ED discharge that provides continuous prolonged cardiac monitoring.
  
  
  METHODS
  We enrolled discharged adult ED patients with symptoms of possible cardiac arrhythmia. A novel, single use continuous recording patch (Zio®Patch) was applied at ED discharge. Patients wore the device for up to 14 days or until they had symptoms to trigger an event. They then returned the device by mail for interpretation. Significant arrhythmias are defined as: ventricular tachycardia (VT) ≥4 beats, supraventricular tachycardia (SVT) ≥4 beats, atrial fibrillation, ≥3 second pause, 2nd degree Mobitz II, 3rd degree AV Block, or symptomatic bradycardia.
  
  
  RESULTS
  There were 174 patients were enrolled and all mailed back their devices. The average age was 52.2 (± 21.0) years, and 55% were female. The most common indications for device placement were palpitations 44.8%, syncope 24.1% and dizziness 6.3%. Eighty-three patients (47.7%) had ≥1 arrhythmias and 17 (9.8%) were symptomatic at the time of their arrhythmia. Median time to first arrhythmia was 1.0 days (IQR 0.2-2.8) and median time to first symptomatic arrhythmia was 1.5 days (IQR 0.4-6.7). 93 (53.4%) of symptomatic patients did not have any arrhythmia during their triggered events. The overall diagnostic yield was 63.2%
  
  
  CONCLUSIONS
  The Zio®Patch cardiac monitoring device can efficiently characterize symptomatic patients without significant arrhythmia and has a higher diagnostic yield for arrhythmias than traditional 24-48 hour Holter monitoring. It allows for longer term monitoring up to 14 days.
authors.affiliation: Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Donald
authors.initials: D
authors.lastname: Schreiber
authors.affiliation: Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Sattar
authors.affiliation: Department of Emergency Medicine, Texas A&M College of Medicine, Temple, Texas.
authors.forename: Dorian
authors.initials: D
authors.lastname: Drigalla
authors.affiliation: Department of Cardiology, Scripps Memorial Hospital, La Jolla, California.
authors.forename: Steven
authors.initials: S
authors.lastname: Higgins
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology; D001919:Bradycardia / Q000175:diagnosis / Q000503:physiopathology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods*; D010351:Patient Discharge; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000503:physiopathology; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology; D013997:Time Factors