Recurrent unexplained palpitations (RUP) study comparison of implantable loop recorder versus conventional diagnostic...

Area of Science:

• Cardiology
• Medical Devices
• Diagnostic Strategies

Background:

• Unexplained palpitations, particularly with infrequent symptoms, pose diagnostic challenges.
• Conventional strategies like short-term ECG monitoring and electrophysiological studies may fail to establish a diagnosis.
• There is a need for more effective diagnostic tools for patients with persistent, unexplained palpitations.

Purpose of the Study:

• To compare the diagnostic yield of implantable loop recorders (ILRs) versus conventional strategies for unexplained palpitations.
• To evaluate and compare the associated healthcare costs of ILR implantation versus the conventional approach.
• To assess the safety and cost-effectiveness of ILR in diagnosing infrequent palpitations.

Main Methods:

• Fifty patients with infrequent, sustained palpitations and negative initial evaluations were randomized.
• One group (n=24) received the conventional strategy: 24-h Holter, 4-week ambulatory ECG monitoring, and electrophysiological study.
• The other group (n=26) received an implantable loop recorder (ILR) with 1-year monitoring; hospital costs were calculated.

Main Results:

• A diagnosis was achieved in 73% of patients with ILR versus 21% with the conventional strategy (p < 0.001).
• The cost per diagnosis was significantly lower with ILR (euro 3,056) compared to the conventional strategy (euro 6,768) (p = 0.012).
• ILR implantation was found to be a safe diagnostic approach in this patient cohort.

Conclusions:

• Implantable loop recorders (ILRs) are a safe and more cost-effective diagnostic method for patients with infrequent palpitations.
• ILR significantly increases diagnostic yield compared to conventional diagnostic strategies.
• This approach is particularly beneficial for patients without severe heart disease experiencing unexplained palpitations.