Use of a Patient-Activated Event Recording System in Patients with Tachycardic Palpitations: How Long to Follow Up?

Introduction Palpitations are a common symptom causing patients to consult a cardiologist, yet diagnosing a potential cardiac origin can be difficult. In patients with a nondiagnostic Holter‐ECG, external loop‐recorders are an additional tool to diagnose the clinical arrhythmia in these patients. The aim of our study was to evaluate the additional value of an external, patient‐activated loop recorder and to determine the optimal time of follow up needed to achieve a symptom–rhythm correlation with the device. Methods and Results A total of 1404 patients presented to our outpatient clinic between November 2011 and November 2014 for first time evaluation of symptomatic arrhythmias. Of a total of 91 patients were included (age 43.6±18.1; 69.2% female) in the study. All patients presented with tachycardic palpitations and a 48‐hour Holter‐ECG that did not detect relevant arrhythmias. All patients were given a “leadless” patient‐activated event‐recording system and regular follow‐up visits were scheduled after 3, 6, and 12 months. Within a maximum follow‐up time of 1 year, 72 patients (79.1%) recorded at least one ECG with the device. Of the recorded ECGs, 51% were recorded within the first week after the device was handed out. This figure rises to 80% and 93% after 1 and 2 months. The last recording was after 174 days. Conclusion For patients with tachycardic palpitations, the external “leadess” event recorders are effective in achieving a symptom–rhythm correlation. A follow up of 2 months will suffice to establish a diagnosis in a large majority of this patient group.