Diagnostic Yield, Outcomes, and Resource Utilization With Different Ambulatory Electrocardiographic Monitoring Strategies

Introduction: Extension of electrocardiographic monitoring via loop recorder implantation may increase the diagnostic yield of syncope work-up. Aim: In this retrospective observational study, the authors wanted to evaluate the diagnostic performance of implantable loop recorder in the everyday clinical practice. Method: The authors analyzed the electronically stored data of all patients who underwent loop recorder implantation between 2005 and 2014 in their cardiology department because of recurrent syncope of undetermined origin. Results: There were 52 loop recorder implantations within the study period. During the 167 (±136) days of monitoring, 36 (69.2%) diagnostic events occurred. In two-thirds of events, (46.2% of all monitored patients) a specific arrhythmia diagnosis was reached, allowing definitive treatment in these cases. In this selected population, there was no correlation between age, presence of known high-risk predictors, or accompanying trauma, and the mechanism of syncope. Conclusions: The high diagnostic rate of implantable loop recorder in the everyday clinical practice is in accordance with the findings in prospective clinical studies. This observation supports the early application of loop recorder in the diagnostic algorithm of syncope. Orv. Hetil., 2015, 156(15), 609–613.

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Electrocardiographic Monitoring Strategies (Holter, Implantable Loop Recorder, in Between)

Encyclopedia of Cardiovascular Research and Medicine ◽

10.1016/b978-0-12-809657-4.99770-9 ◽

2018 ◽

pp. 197-210 ◽

Cited By ~ 1

Author(s):

H. Nazzari ◽

L. Halperin ◽

A.D. Krahn

Keyword(s):

Implantable Loop Recorder ◽

Loop Recorder ◽

Electrocardiographic Monitoring ◽

Monitoring Strategies

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OBSOLETE: Electrocardiographic Monitoring Strategies (Holter, Implantable Loop Recorder, in Between)

Reference Module in Biomedical Sciences ◽

10.1016/b978-0-12-801238-3.99770-8 ◽

2018 ◽

Author(s):

A.D. Krahn

Keyword(s):

Implantable Loop Recorder ◽

Loop Recorder ◽

Electrocardiographic Monitoring ◽

Monitoring Strategies

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Randomized Controlled Trial Comparing Outcomes of Video Capsule Endoscopy with Push Enteroscopy in Obscure Gastrointestinal Bleeding

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2015/897567 ◽

2015 ◽

Vol 29 (2) ◽

pp. 85-90 ◽

Cited By ~ 12

Author(s):

Dev S Segarajasingam ◽

Stephen C Hanley ◽

Alan N Barkun ◽

Kevin A Waschke ◽

Pascal Burtin ◽

...

Keyword(s):

Small Bowel ◽

Gastrointestinal Bleeding ◽

Resource Utilization ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Video Capsule Endoscopy ◽

Health Resource ◽

Health Resource Utilization ◽

Push Enteroscopy

BACKGROUND: Optimal management of obscure gastrointestinal bleeding (OGIB) remains unclear.OBJECTIVE: To evaluate diagnostic yields and downstream clinical outcomes comparing video capsule endoscopy (VCE) with push enteroscopy (PE).METHODS: Patients with OGIB and negative esophagogastroduodenoscopies and colonoscopies were randomly assigned to VCE or PE and followed for 12 months. End points included diagnostic yield, acute or chronic bleeding, health resource utilization and crossovers.RESULTS: Data from 79 patients were analyzed (VCE n=40; PE n=39; 82.3% overt OGIB). VCE had greater diagnostic yield (72.5% versus 48.7%; P<0.05), especially in the distal small bowel (58% versus 13%; P<0.01). More VCE-identified lesions were rated possible or certain causes of bleeding (79.3% versus 35.0%; P<0.05). During follow-up, there were no differences in the rates of ongoing bleeding (acute [40.0% versus 38.5%; P not significant], chronic [32.5% versus 45.6%; P not significant]), nor in health resource utilization. Fewer VCE-first patients crossed over due to ongoing bleeding (22.5% versus 48.7%; P<0.05).CONCLUSIONS: A VCE-first approach had a significant diagnostic advantage over PE-first in patients with OGIB, especially with regard to detecting small bowel lesions, affecting clinical certainty and subsequent further small bowel investigations, with no subsequent differences in bleeding or resource utilization outcomes in follow-up. These findings question the clinical relevance of many of the discovered endoscopic lesions or the ability to treat most of these effectively over time. Improved prognostication of both patient characteristics and endoscopic lesion appearance with regard to bleeding behaviour, coupled with the impact of therapeutic deep enteroscopy, is now required using adapted, high-quality study methodologies.

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Usefulness of a smartphone-based event recorder for ambulatory patients presenting with palpitations

European Heart Journal ◽

10.1093/eurheartj/ehab724.0321 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M E Salar Alcaraz ◽

F Buendia Santiago ◽

P J Flores Blanco ◽

E Cabrera Romero ◽

D Fernandez Vazquez ◽

...

Keyword(s):

Primary Care Physicians ◽

Diagnostic Yield ◽

Event Recorder ◽

Funding Sources ◽

Electrocardiographic Monitoring ◽

Technological Advances ◽

Cardiology Department ◽

History Of ◽

Electrocardiographic Findings ◽

Electrocardiogram Ecg

Abstract Background Palpitations are a common complaint among patients seen by primary care physicians (16%). Recent technological advances have led to several novel electrocardiographic monitoring devices. AliveCor Kardia Mobile® (AliveCor, Inc., Mountain View, CA, USA) is a smartphone-based event recorder that allows take an electrocardiogram (ECG) recording during 30 seconds. The usefulness of this device has been studied in atrial fibrillation screening, however, its usefulness in the diagnosis of palpitations is not well known. Objective Evaluate the diagnostic yield of the AliveCor Kardia Mobile® device in unselected patients referred to the cardiologist for the study of palpitations. Methods Uni-centre retrospective study. From September 2018 to October 2020, consecutive patients with palpitations referred to cardiology department were included. After an initial evaluation it was decided monitoring ECG of these patients with this device if they had access to a compatible smartphone. They were instructed to record ECG when they had symptoms. ECG tracings and clinical characteristics were analysed. Results 152 patients were included. Mean age 42±15 years, 68% female. Most of the patients did not have heart disease and about 25% had a history of anxiety-depressive syndrome (Table 1). After monitoring, 31 (20%) patients had rhythm disturbances during symptoms, 82 (54%) patients had no rhythm disturbances related to the symptoms and 39 (26%) patients had no symptoms. Table 2 shows the electrocardiographic findings. Patients with palpitations of arrhythmic origin were older and presented less anxiety/depression (Table 1). Age was the only independent predictor of palpitations of arrhythmic origin (OR, × year: 1.03, 95% CI 1.01–1.06; p=0.035). Conclusions The AliveCor Kardia Mobile® device is easy to use and diagnosed the aetiology of palpitations in a high proportion of patients (74%) referred for specialist evaluation. FUNDunding Acknowledgement Type of funding sources: None.

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