Diagnostic yield and optimal duration of continuous-loop event monitoring for the diagnosis of palpitations. A
P J Zimetbaum1, K Y Kim, M E Josephson
1Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02115, USA.
Background:
Continuous-loop event recorders are widely used for the evaluation of palpitations, but the optimal duration of monitoring is unknown.
Objective:
To determine the yield, timing, and incremental cost-effectiveness of each week of event monitoring for palpitations.
Design:
Prospective cohort study.
Patients:
105 consecutive outpatients referred for the placement of a continuous-loop event recorder for the evaluation of palpitations.
Measurements:
Diagnostic yield, incremental cost, and cost-effectiveness for each week of monitoring.
Results:
The diagnostic yield of continuous-loop event recorders was 1.04 diagnoses per patient in week 1, 0.15 diagnoses per patient in week 2, and 0.01 diagnoses per patient in week 3 and beyond. Over time, the cost-effectiveness ratio increased from $98 per new diagnosis in week 1 to $576 per new diagnosis in week 2 and $5832 per new diagnosis in week 3.
Conclusions:
In patients referred for evaluation of palpitations, the diagnostic yield of continuous-loop event recording decreases rapidly after 2 weeks of monitoring. A 2-week monitoring period is reasonably cost-effective for most patients and should be the standard period for continuous-loop event recording for the evaluation of palpitations.
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