Cardiac monitoring for patients with palpitations

Table 3 Summary of relevant studies on diagnostic yield for palpitations according to the different types of devices

Ref.	No. of patients	Study design	Study population	Duration of monitoring	Diagnostic yield	Other findings
Holter 24 h
Sulfi et al[22], 2008	2688	Retrospective cohort	Palpitations and basal sinus rhythm	24 h	16%	Even less diagnostic yield in patients aged < 50 yr
Paudel et al[103], 2013	335	Single-center prospective cohort	Palpitations	24 h	75%	40% of patients with ventricular ectopy considered as diagnostic finding (possible selection bias)
ECG patchs
Barrett et al[59], 2014	146	Prospective cohort comparing Patch vs 24 h Holter	Palpitations	15 d	60% more diagnostics than 24 h Holter	Over 90% of patients were comfortable with it. Best diagnostic yield during first week
Event recorders
Narasimha et al[104], 2018	38	Prospective cohort comparing Kardia Mobile vs ELR (simultaneously)	Palpitations (less often than daily but more than monthly)	14–30 d	89.5% vs 68% in ELR group	Better compliance with Kardia Mobile
Hall et al[63], 2020	11 studies (> 20000 patients)	Systematic review	AF screening in general population	Heterogeneous	Up to 36% (depending of population’s AF burden)	More diagnostic yield in people aged > 65 yr. Approximately 4% of uninterruptable registries
ELR
Locati et al[54], 2016	392 (282 with palpitations)	Prospective cohort	> 2 episodes in last year	4 wk	71.6%	Early recorder use increase diagnostic yield. Diagnostic yield for syncope: 24.5%
Francisco-Pascual et al[2], 2019	149 (91 in ELR group)	Prospective ELR cohort compared with historical Holter cohort	> 2 episodes in last year	21 d	86.8%	Holter diagnostic yield: 20.7%. ELR reduce the cost per diagnosis
ILR
Giada et al[29], 2007	50 (26 in ILR group)	Prospective cohort comparing ILR with conventional strategy	1 episode per month or less (longer than 1 min)	321 d (mean)	73%	Mean time to diagnosis: 279 d. Lower cost per diagnosis in ILR group
Padmanabhan et al[83], 2019	312 (51 with palpitations)	Prospective cohort of consecutive patients with an ILR implanted	Any indication form monitoring (16.3% due to palpitations)	579 d (mean)	64.7%	38.7% useful in ruling out an arrhythmic cause for symptoms (all indications). 12% AF.

ELR: External loop recorders; AF: Atrial fibrillation; ILR: Implantable loop recorders.