Abstract 2701: Detection of Malignant Cardiac Arrhythmias: A Prospective Multi-center Randomized Study comparing Mobile Cardiac Outpatient Telemetry versus Standard Loop Event Monitor
Background: The outpatient evaluation of symptoms suggestive of a cardiac arrhythmia is typically confined to the use of low yield methods such as Holter monitoring and cardiac event recorders. Newer ambulatory technologies such as continuous on-line telemetry have the potential to increase the diagnostic yield and improve patient care. The purpose of this study was to assess the relative value of an outpatient telemetry system in patients with symptoms suggestive of a significant cardiac arrhythmia.
Methods: The study was an 18 center, prospective, parallel clinical trial with patients randomized to either standard loop event monitoring (LOOP) or to mobile cardiac outpatient telemetry (MCOT) for up to 30 days. Subjects with symptoms of syncope, presyncope, or severe palpitations who had a non-diagnostic 24 hour Holter monitor were randomized. The primary endpoint was the confirmation or exclusion of a probable arrhythmic cause of their symptoms. Secondary endpoints included the detection of both symptomatic and nonsymptomatic clinically significant arrhythmias and time to diagnosis.
Results: 305 subjects (pts) were randomized equally. The study population was 36% male with an average age of 554 years. Forty-eight percent of the study population had hypertension and 18% had coronary artery disease. The presenting symptoms were pre-syncope (33%), syncope (16%), and severe palpitations (81%). An arrhythmogenic cause of the subjects symptoms was detected or ruled out in 55% of MCOT patients and 45% of LOOP patients. Clinically significant arrhythmias were detected in 38% of MCOT subjects compared with 14% of LOOP subjects (p<0.001).
Conclusion: When compared with standard event monitors, mobile cardiac outpatient telemetry provides a greater yield in the diagnosis of patients with symptoms of presyncope, syncope and palpitations.