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Efficacy of diagnostic tools for detecting cardiac arrhythmias: systematic literature search
E Hoefman1, P J E Bindels, H C P M van Weert
1Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Insights
Diagnosing cardiac arrhythmias requires advanced tools beyond physical exams. Event recorders and implantable devices offer higher diagnostic yields for palpitations than traditional Holter monitors.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Cardiac arrhythmias present diagnostic challenges due to their paroxysmal nature.
- Traditional methods like physical examination and 12-lead ECG have limited diagnostic value for intermittent rhythm disturbances.
Purpose of the Study:
- To review the medical literature and develop a guide for rational diagnostic testing of cardiac arrhythmias.
- To evaluate the effectiveness of various diagnostic tools for identifying rhythm disturbances.
Main Methods:
- A systematic literature search was conducted in MEDLINE and EMBASE for primary studies on diagnostic tools for palpitations.
- Included studies evaluated the yield of different diagnostic devices and strategies.
Main Results:
- Event recorders demonstrated higher diagnostic yields compared to Holter monitors.
- Automatically triggered recorders were more effective in detecting arrhythmias (72-80%) than patient-triggered devices (17-75%).
- Implantable devices are suitable for prolonged monitoring in patients with infrequent symptoms or syncope.
Conclusions:
- The selection of a diagnostic device should be tailored to individual patient symptoms and characteristics.
- Methodological limitations in current studies prevent the proposal of an evidence-based diagnostic strategy.
Background/Objectives:
Symptoms suggestive of cardiac arrhythmias are a challenge to the diagnosis. Physical examination and a 12-lead ECG are of limited value, as rhythm disturbances are frequently of a paroxysmal nature. New technologies facilitate a more accurate diagnosis. The objective of this study was to review the medical literature in an effort to define a guide to rational diagnostic testing.
Methods:
Primary studies on the use of a diagnostic tool in the evaluation of palpitations were searched in MEDLINE, and EMBASE with an additional reference check.
Results:
TWO TYPES OF STUDIES WERE FOUND: descriptive and experimental studies, which compared the yield of two or more devices or diagnostic strategies. Holter monitors seemed to have less diagnostic yield (33 to 35%) than event recorders. Automatically triggered recorders detect more arrhythmias (72 to 80%) than patient-triggered devices (17 to 75%). Implantable devices are used for prolonged monitoring periods in patients with infrequent symptoms or unexplained syncope.
Conclusion:
The choice of the device depends on the characteristics of the symptoms and the patient. Due to methodological shortcomings of the included studies no evidence-based diagnostic strategy can be proposed. (Neth Heart J 2010;18:543-51.).
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