[Evaluation of infrequent episodes of palpitations with a patient-activated hand-held electrocardiograph]

The disadvantage of most devices presently available for cardiac rhythm event monitoring is that they require either permanently attached electrodes or the subcutaneous implantation of the device. The aim of the study was to evaluate the feasibility and diagnostic yield of a hand-held, portable electrocardiograph for the evaluation of infrequent episodes of palpitations. In contrast to other devices, this electrocardiograph records and stores the electrocardiograms with integral electrodes, which makes long-term attached electrodes not unnecessary.

The study included 55 consecutive patients with palpitations less than once a week. The patients received the electrocardiograph Miniscope MS-3 with integral tripod electrodes (Schiller AG, Switzerland) to record a one-channel electrocardiogram during a recurrent episode. The frequency of device activation and the atrial rhythm during an episode was assessed.

Forty-one (75%) patients had at least one episode within 38 +/- 22 days. The first episode occurred within the first week in 18 cases, during the 2nd in 9, during the 3rd in 9, during the 4th in 2 patients, and in 3 patients between the 4th and 12th week. All episodes could be properly analyzed: Twenty-three patients had sinus rhythm, 7 paroxysmal atrial fibrillation, 7 paroxysmal atrial flutter, and 4 an AV node reentry tachycardia. Eleven of the 23 patients with sinus rhythm additionally had premature atrial or ventricular contractions. Mean heart rate was 111 +/- 45 bpm. A second episode was recorded in 22 and a third episode in 12 patients. All patients had during the subsequent episode the same cardiac rhythm as during their first episode.

Patients evaluated for their infrequent palpitations had during event monitoring a recurrent episode in 75% that occurred in 88% within the first 4 weeks. All patients were able to activate the electrocardiograph and could store an electrocardiogram with the integral electrodes. Patient-activated event monitoring reliably identified patients with an atrial arrhythmia who need further invasive evaluation and treatment, and ruled out patients with sinus rhythm and premature contractions.