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Heart Palpitations Patient

HEART PALPITATIONS CARDIAC DIAGNOSTICS & MONITORING

Find the answer with cardiac monitoring.

THE CHALLENGE OF HEART PALPITATIONS

  • Palpitations account for 16% of symptoms that prompt patients to visit a general practitioner1
  • It is the second most common complaint for specialist cardiologic evaluation (1st: chest pain)2 
  • Symptom with broad range of causes; usually benign but some are life threatening
  • Generally transitory, patients are often asymptomatic during evaluation
  • Even after extensive testing, it is not always possible to establish a definite cause
  • Frequent and recurrent palpitations can impair a patient's quality of life1
  • The following conditions increase the likelihood of an abnormal heart rhythm:
    • Tachyarrhythmias
    • Structural heart disease
    • Bradyarrhythmias 

SOCIETY RECOMMENDATIONS & GUIDELINES

INSERTABLE CARDIAC MONITORING

EHRA Recommendations3

The European Heart Rhythm Association (EHRA) recommends insertable loop recorders (insertable cardiac monitors) like Reveal LINQ™ ICM for palpitations for the following indications:

  • Increasing monthly in frequency
  • Associated with hemodynamic compromise
  • Other listed examinations prove inconclusive
  • Non-compliant patients without hemodynamic compromise when a clinically significant arrhythmic cause is likely or must be ruled out

EHRA Recommendations Chart

ACC/AHA Ambulatory ECG Guidelines 20004

These guidelines represent some of the current common clinical uses of ambulatory ECG.

For Assessment of Symptoms of Cardiac Arrhythmias

Class Recommended Use
Class

I

 Recommended Use
  1. Patients with unexplained syncope, near syncope, or episodic dizziness without obvious cause.
  2. Patients with unexplained recurrent palpitation.
Class

IIb

 Recommended Use
  1. Patients with episodic shortness of breath, chest pain, or fatigue that is not otherwise explained.
  2. Patients with neurologic events when transient atrial fibrillation or flutter is suspected.
  3. Patients with symptoms such as syncope, near syncope, episodic dizziness, or palpitation in whom a probable cause other than an arrhythmia has been identified but in whom symptoms persist despite treatment of this other cause.

Indications for AECG to Assess Symptoms Possibly Related to Rhythm Disturbances
Class

I

 Recommended Use
  1. Patients with unexplained syncope, near syncope, or episodic dizziness without obvious cause.
  2. Patients with unexplained recurrent palpitation.
Class

IIb

 Recommended Use
  1. Patients with episodic shortness of breath, chest pain, or fatigue that is not otherwise explained.
  2. Patients with neurologic events when transient atrial fibrillation or flutter is suspected.
  3. Patients with symptoms such as syncope, near syncope, episodic dizziness, or palpitation in whom a probable cause other than an arrhythmia has been identified but in whom symptoms persist despite treatment of this other cause.

EVIDENCE FOR CARDIAC MONITORING

Reveal ICM: Clinical and Cost Effectiveness5

Higher Diagnostic Yield, Lower Cost for Palpitations Diagnosis

Reveal ICM has been shown to be both clinically effective and cost effective when treating palpitations.

Results of the RUP study show:

  • A 73% diagnostic yield for Reveal ICM, compared to a 21% yield for conventional tests
  • Conventional testing arm was 121% more expensive than ICM arm.

Palpitations Rup Study Chart

1

Kroenke K, et al. Ann Intern Med. 2001 May 1;134(9 Pt 1):783-5. Arch Intern Med. 1990 Aug;150(8):1586-7.

2

Mayou RA. Chest pain, palpitations and panic. J Psychosom Res. 1998;44:53—70.

3

Raviele A. et al. Management of patients with palpitations: a position paper from the European Heart Rhythm Association. Europace (2011) 13, 920–934

4

ACC/AHA Guidelines for Ambulatory Electrocardiography: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography). JACC. 1999.

5

Giada F, et al. Recurrent unexplained palpitations (RUP) study comparison of implantable loop recorder versus conventional diagnostic strategy. J Am Coll Cardiol. 2007. 49:19:1951-6.