CARDIAC EVENT RECORDERS YIELD MORE DIAGNOSES AND ARE MORE COST-EFFECTIVE THAN 48-HOUR HOLTER MONITORING IN PATIENTS WITH PALPITATIONS - A CONTROLLED CLINICAL-TRIAL

Objective: To compare the diagnostic yield and cost-effectiveness of t ranstelephonic event monitors with those of Hotter monitoring in patie nts with intermittent palpitations. Design: Randomized crossover trial . Setting: Diagnostic service of a teaching hospital and surrounding p rimary care practices. Patients: 43 patients with previously uninvesti gated palpitations who were referred for Holter monitoring. Measuremen ts: Patients were randomly allocated to receive an event monitor or 48 -hour Holter monitor and then to receive the other device. Event monit ors were used for 3 months or until two recordings were obtained while symptoms occurred. The main end point was an electrogram recorded dur ing symptoms. The incremental cost-effectiveness of obtaining a diagno stic rhythm strip from event monitors was compared with that of Holter monitoring. Results: The mean (+/-SD) patient age was 45 +/- 19 years ; 37 patients (88%) were women. Event monitors were twice as likely to provide a diagnostic rhythm strip electrocardiogram during symptoms a s 48-hour Holter monitoring (29 patients [67%] and 15 patients [35%], respectively; P < 0.001). Event monitors detected 8 patients (19%) wit h clinically important arrhythmias (6 patients with supraventricular t achycardia and 2 with atrial fibrillation or flutter), whereas the Hot ter monitors detected no significant arrhythmia (P < 0.005). With the event monitors, most patients transmitted an electrocardiogram recordi ng by 6 weeks. Event monitors were dominant and therefore more cost-ef fective than 48-hour Holter monitoring, resulting in a cost savings of $213 for each additional diagnostic rhythm strip obtained during symp toms. Conclusions: Holter monitoring is a poor diagnostic test for int ermittent palpitations. Event recorders provide better data and are mo re cost-effective.