Mobile Cardiac Outpatient Telemetry for the Diagnosis of Presyncope/syncope
Mobile Cardiac Outpatient Telemetry for the Diagnosis of Presyncope/syncope
Introduction: Continuous mobile cardiac outpatient telemetry (MCOT) may have several advantages over traditional ambulatory monitoring systems in the diagnostic evaluation of symptoms such as palpitations, dizziness, and syncope. However, only limited published data are available showing its advantages.
Methods and Results: We reviewed the records of 122 consecutive patients evaluated using MCOT for palpitations, presyncope/syncope, or to monitor the efficacy of a specific antiarrhythmic therapy. Ten of 17 patients (59%) studied for presyncope/syncope had a diagnosis made with MCOT. Eight of these 17 patients had a previous negative evaluation for presyncope/syncope and five had an event correlated with the heart rhythm during the monitoring period. Nineteen patients monitored for palpitations or presyncope/syncope were asymptomatic during monitoring but had a prespecified arrhythmia detected. When MCOT was used as the first ambulatory monitoring system to evaluate palpitations (n = 18), 73% of patients correlated their symptoms with the underlying cardiac rhythm. Seven of 21 patients monitored for medication titration had dosage adjustments during outpatient monitoring.
Conclusions: MCOT can detect asymptomatic clinically significant arrhythmias, and was especially useful to identify the cause of presyncope/syncope, even in patients with a previous negative workup. This outpatient monitoring system allows patients to undergo daily medication dose titration in the outpatient setting, thus avoiding hospitalization.
Symptoms that may be secondary to an arrhythmia such as palpitations, dizziness, and syncope occur commonly. The key to the correct diagnosis is documentation of the underlying heart rhythm when symptoms occur. Traditionally, two noninvasive methods have been used, 24-hour electrocardiographic recorder (Holter) and transtelephonic electrocardiographic recorder (event recorder) monitoring. The yield for the diagnosis of palpitations is relatively low during event recorder (67-83%) and Holter monitoring (35-39%). The diagnostic yield for presyncope/syncope using an event monitor is even lower at 6-31%. Further, clinically important arrhythmias, for example, atrial fibrillation (AF), are often asymptomatic. Such asymptomatic arrhythmias will not be detected by a patient-event recorder and will likely be missed on a 24-hour Holter recording. The utility of event recorders is further limited by the observation that nearly one in four patients does not activate the recorder during symptomatic episodes despite previous education to do so.
Recently, continuous mobile cardiac outpatient telemetry (MCOT, Cardionet recorder) has become available as an alternative to conventional ambulatory monitoring. MCOT has several advantages over event recorders and Holter monitors. It provides continuous, real-time outpatient electrocardiographic monitoring for extended time periods and has the ability to autodetect asymptomatic arrhythmias. When patients activate the device, they can also submit their symptoms and level of activity from a menu on the device. To date, the clinical utility of this novel monitoring system has had limited study. We evaluated the diagnostic utility of MCOT in patients with palpitations and presyncope/syncope and its ability to aid in medication titration on an outpatient basis.
Abstract and Introduction
Abstract
Introduction: Continuous mobile cardiac outpatient telemetry (MCOT) may have several advantages over traditional ambulatory monitoring systems in the diagnostic evaluation of symptoms such as palpitations, dizziness, and syncope. However, only limited published data are available showing its advantages.
Methods and Results: We reviewed the records of 122 consecutive patients evaluated using MCOT for palpitations, presyncope/syncope, or to monitor the efficacy of a specific antiarrhythmic therapy. Ten of 17 patients (59%) studied for presyncope/syncope had a diagnosis made with MCOT. Eight of these 17 patients had a previous negative evaluation for presyncope/syncope and five had an event correlated with the heart rhythm during the monitoring period. Nineteen patients monitored for palpitations or presyncope/syncope were asymptomatic during monitoring but had a prespecified arrhythmia detected. When MCOT was used as the first ambulatory monitoring system to evaluate palpitations (n = 18), 73% of patients correlated their symptoms with the underlying cardiac rhythm. Seven of 21 patients monitored for medication titration had dosage adjustments during outpatient monitoring.
Conclusions: MCOT can detect asymptomatic clinically significant arrhythmias, and was especially useful to identify the cause of presyncope/syncope, even in patients with a previous negative workup. This outpatient monitoring system allows patients to undergo daily medication dose titration in the outpatient setting, thus avoiding hospitalization.
Introduction
Symptoms that may be secondary to an arrhythmia such as palpitations, dizziness, and syncope occur commonly. The key to the correct diagnosis is documentation of the underlying heart rhythm when symptoms occur. Traditionally, two noninvasive methods have been used, 24-hour electrocardiographic recorder (Holter) and transtelephonic electrocardiographic recorder (event recorder) monitoring. The yield for the diagnosis of palpitations is relatively low during event recorder (67-83%) and Holter monitoring (35-39%). The diagnostic yield for presyncope/syncope using an event monitor is even lower at 6-31%. Further, clinically important arrhythmias, for example, atrial fibrillation (AF), are often asymptomatic. Such asymptomatic arrhythmias will not be detected by a patient-event recorder and will likely be missed on a 24-hour Holter recording. The utility of event recorders is further limited by the observation that nearly one in four patients does not activate the recorder during symptomatic episodes despite previous education to do so.
Recently, continuous mobile cardiac outpatient telemetry (MCOT, Cardionet recorder) has become available as an alternative to conventional ambulatory monitoring. MCOT has several advantages over event recorders and Holter monitors. It provides continuous, real-time outpatient electrocardiographic monitoring for extended time periods and has the ability to autodetect asymptomatic arrhythmias. When patients activate the device, they can also submit their symptoms and level of activity from a menu on the device. To date, the clinical utility of this novel monitoring system has had limited study. We evaluated the diagnostic utility of MCOT in patients with palpitations and presyncope/syncope and its ability to aid in medication titration on an outpatient basis.
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