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Sharma AN, Baranchuk A. Ambulatory External Electrocardiography Monitoring: Holter, Extended Holter, Mobile Cardiac Telemetry Monitoring. Card Electrophysiol Clin 2021; 13:427-438. [PMID: 34330370 DOI: 10.1016/j.ccep.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ambulatory external electrocardiography (AECG) monitoring is effective as an evidence-based diagnostic tool when suspicion for cardiac arrhythmia is high. Multiple modalities of AECG monitoring exist, with unique advantages and limitations that predict effectiveness in a variety of clinical settings. Knowledge of these characteristics allows appropriate use of AECG, maximizing patient adherence, diagnostic yield, and cost-effectiveness. In addition, new technology has allowed the development of a modern generation of devices that offer increased efficacy and functionality compared with Holter monitors.
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Affiliation(s)
- Arjun N Sharma
- Internal Medicine, Department of Medicine, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada
| | - Adrian Baranchuk
- Department of Cardiac Electrophysiology and Pacing, Kingston General Hospital, Kingston, Ontario, Canada; Department of Cardiology, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
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2
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Comparison between a 6‑lead smartphone ECG and 12‑lead ECG in athletes. J Electrocardiol 2021; 66:95-97. [PMID: 33878565 DOI: 10.1016/j.jelectrocard.2021.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 11/20/2022]
Abstract
Athletes sometimes experience transient arrhythmias during intense exercise, which may be difficult to capture with traditional Holter monitors. New and highly portable technology, such as smartphone electrocardiogram (ECG) devices, may be useful in documenting and contribute to diagnosis of exercise-induced arrhythmias. There are little data available regarding the new Kardia 6 lead device (6L) and no data regarding its use in athletic populations. In this short communication, we present pilot data from 30 healthy athletes who underwent a 12‑lead ECG and subsequent 6L reading. Our pilot data show relatively high levels of agreement for QTc and PR interval and QRS duration, with the 6L readings slightly but significantly shorter on average.
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Rajanna RREDDY, Natarajan S, Prakash V, Vittala PR, Arun U, Sahoo S. External Cardiac Loop Recorders: Functionalities, Diagnostic Efficacy, Challenges and Opportunities. IEEE Rev Biomed Eng 2021; 15:273-292. [DOI: 10.1109/rbme.2021.3055219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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4
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Application of Appropriate Use Criteria for Echocardiography in Pediatric Patients with Palpitations and Arrhythmias. Pediatr Qual Saf 2020; 5:e364. [PMID: 33134762 PMCID: PMC7591125 DOI: 10.1097/pq9.0000000000000364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/14/2020] [Indexed: 11/25/2022] Open
Abstract
Before the integration of the pediatric appropriate use criteria (AUC) for initial transthoracic echocardiography (TTE) in the outpatient setting with our electronic medical record (EMR), there was a high proportion of “rarely appropriate” TTEs (17.2%) ordered for palpitations/arrhythmias. We studied appropriateness ratings and applicability of pediatric AUC on the initial outpatient evaluation of children with palpitations/arrhythmias after EMR integration and the yield of abnormal TTEs for these indications.
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Noah B, Keller MS, Mosadeghi S, Stein L, Johl S, Delshad S, Tashjian VC, Lew D, Kwan JT, Jusufagic A, Spiegel BMR. Impact of remote patient monitoring on clinical outcomes: an updated meta-analysis of randomized controlled trials. NPJ Digit Med 2018; 1:20172. [PMID: 31304346 PMCID: PMC6550143 DOI: 10.1038/s41746-017-0002-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 12/31/2022] Open
Abstract
Despite growing interest in remote patient monitoring, limited evidence exists to substantiate claims of its ability to improve outcomes. Our aim was to evaluate randomized controlled trials (RCTs) that assess the effects of using wearable biosensors (e.g. activity trackers) for remote patient monitoring on clinical outcomes. We expanded upon prior reviews by assessing effectiveness across indications and presenting quantitative summary data. We searched for articles from January 2000 to October 2016 in PubMed, reviewed 4,348 titles, selected 777 for abstract review, and 64 for full text review. A total of 27 RCTs from 13 different countries focused on a range of clinical outcomes and were retained for final analysis; of these, we identified 16 high-quality studies. We estimated a difference-in-differences random effects meta-analysis on select outcomes. We weighted the studies by sample size and used 95% confidence intervals (CI) around point estimates. Difference-in-difference point estimation revealed no statistically significant impact of remote patient monitoring on any of six reported clinical outcomes, including body mass index (-0.73; 95% CI: -1.84, 0.38), weight (-1.29; -3.06, 0.48), waist circumference (-2.41; -5.16, 0.34), body fat percentage (0.11; -1.56, 1.34), systolic blood pressure (-2.62; -5.31, 0.06), and diastolic blood pressure (-0.99; -2.73, 0.74). Studies were highly heterogeneous in their design, device type, and outcomes. Interventions based on health behavior models and personalized coaching were most successful. We found substantial gaps in the evidence base that should be considered before implementation of remote patient monitoring in the clinical setting.
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Affiliation(s)
- Benjamin Noah
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Michelle S Keller
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - Sasan Mosadeghi
- 4Department of Medicine, University of Arizona, College of Medicine Tucson, Tucson, AZ USA
| | - Libby Stein
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Sunny Johl
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Sean Delshad
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Vartan C Tashjian
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,5Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Daniel Lew
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,5Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - James T Kwan
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Alma Jusufagic
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - Brennan M R Spiegel
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA.,5Cedars-Sinai Medical Center, Los Angeles, CA USA.,American Journal of Gastroenterology, Bethesda, USA
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Anczykowski J, Willems S, Hoffmann BA, Meinertz T, Blankenberg S, Patten M. Early Detection of Symptomatic Paroxysmal Cardiac Arrhythmias by Trans-Telephonic ECG Monitoring: Impact on Diagnosis and Treatment of Atrial Fibrillation. J Cardiovasc Electrophysiol 2016; 27:1032-7. [PMID: 27257094 DOI: 10.1111/jce.13025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 05/11/2016] [Accepted: 05/16/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Diagnosis of infrequent cardiac arrhythmias (CA) is often unsuccessful using resting or Holter ECG. As early detection and treatment of CA, especially atrial fibrillation (AF), has implications on patients' treatment and outcome, we investigated, whether self-guided, trans-telephonic event-recorder monitoring (Tele-ECG) improves diagnosis and influences treatment options. METHODS Between 2009 and 2014, 790 patients (54 ± 18 years, 40% male; no history of CA: 582, known AF: 179, other CA: 29) presented with recurrent symptoms suggestive of CA and were screened by Tele-ECG (17.3 ± 26.9 days). A total of 11,775 ECGs were transmitted via a 24-hour telephone hotline including documentation of the respective symptoms. RESULTS In 73% of patients, CA was documented at the time of symptoms: sinus tachycardia 23%, premature ventricular beats 19%, AF 14%, supraventricular tachycardia 9%, sinus bradycardia 5%, sinus arrhythmia 2%, and AV block II 1%. The mean time until the first symptomatic episode occurred was 6.9 ± 15.3 days (median 2.5 days). The first documented arrhythmia occurred on average after 7.7 ± 14.1 days (median 3 days). In patients with AF (n = 110), 44% was newly diagnosed. According to the Tele-ECG diagnosis, AF ablation was performed in 27% of these patients, 7% electrical cardioversion, and in 30% antiarrhythmic therapy was initiated. In 65% of the patients with recurrence of known AF, (re-)ablation was performed or recommended and in 16% antiarrhythmic therapy was modified. CONCLUSIONS Tele-ECG monitoring is effective in the diagnosis of suspected symptomatic CA. A diagnosis can usually be achieved within 1 week and has implications on patients' care.
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Affiliation(s)
- Johanna Anczykowski
- Department of Clinical and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology - Electrophysiology, University Heart Center Hamburg, Hamburg, Germany
| | - Boris A Hoffmann
- Department of Cardiology - Electrophysiology, University Heart Center Hamburg, Hamburg, Germany
| | - Thomas Meinertz
- Department of Clinical and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Clinical and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Monica Patten
- Department of Clinical and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
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Vegesna A, Tran M, Angelaccio M, Arcona S. Remote Patient Monitoring via Non-Invasive Digital Technologies: A Systematic Review. Telemed J E Health 2016; 23:3-17. [PMID: 27116181 PMCID: PMC5240011 DOI: 10.1089/tmj.2016.0051] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND We conducted a systematic literature review to identify key trends associated with remote patient monitoring (RPM) via noninvasive digital technologies over the last decade. MATERIALS AND METHODS A search was conducted in EMBASE and Ovid MEDLINE. Citations were screened for relevance against predefined selection criteria based on the PICOTS (Population, Intervention, Comparator, Outcomes, Timeframe, and Study Design) format. We included studies published between January 1, 2005 and September 15, 2015 that used RPM via noninvasive digital technology (smartphones/personal digital assistants [PDAs], wearables, biosensors, computerized systems, or multiple components of the formerly mentioned) in evaluating health outcomes compared to standard of care or another technology. Studies were quality appraised according to Critical Appraisal Skills Programme. RESULTS Of 347 articles identified, 62 met the selection criteria. Most studies were randomized control trials with older adult populations, small sample sizes, and limited follow-up. There was a trend toward multicomponent interventions (n = 26), followed by smartphones/PDAs (n = 12), wearables (n = 11), biosensor devices (n = 7), and computerized systems (n = 6). Another key trend was the monitoring of chronic conditions, including respiratory (23%), weight management (17%), metabolic (18%), and cardiovascular diseases (16%). Although substantial diversity in health-related outcomes was noted, studies predominantly reported positive findings. CONCLUSIONS This review will help decision makers develop a better understanding of the current landscape of peer-reviewed literature, demonstrating the utility of noninvasive RPM in various patient populations. Future research is needed to determine the effectiveness of RPM via noninvasive digital technologies in delivering patient healthcare benefits and the feasibility of large-scale implementation.
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Affiliation(s)
- Ashok Vegesna
- 1 Jefferson College of Population Health , Philadelphia, Pennsylvania.,2 Novartis Pharmaceuticals Corporation , East Hanover, New Jersey
| | - Melody Tran
- 2 Novartis Pharmaceuticals Corporation , East Hanover, New Jersey.,3 Scott & White Health Plan , Temple, Texas
| | | | - Steve Arcona
- 2 Novartis Pharmaceuticals Corporation , East Hanover, New Jersey
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Abstract
Cardiovascular disease is one of the main fields of application for telemedicine, with benefits in almost all areas in the continuum of cardiovascular disease. The greatest impact has been shown in the early diagnosis of cardiovascular disease, in second consultation, between non-cardiologist and cardiologist and between cardiologists, and in follow-up and secondary prevention of cardiovascular disease. At present, the main area of implementation for telemedicine in cardiovascular disease is represented by pre-hospital triage, with telemedicine electrocardiogram in acute myocardial infarction. Significant results have also been achieved in the second opinion consultation of pediatric subjects with congenital cardiovascular disease, home-monitoring and the management of patients affected by chronic heart failure or with an implanted device. However, there is significant room for further improvement in delivering telemedicine assistance even in 'very-remote' populations, such as detainees, patients in developing countries or in underdeveloped areas of developed countries.
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Affiliation(s)
| | - Simonetta Scalvini
- b U.O. Cardiologia Riabilitativa , IRCCS Fondazione Salvatore Maugeri , Brescia , Italy
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9
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Diagnostic yield of external loop recording in patients with acute ischemic stroke or TIA. J Neurol 2015; 262:682-8. [DOI: 10.1007/s00415-014-7621-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 12/16/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
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Álvarez Gaviria M, Herazo Bustos C, Mora G. Enfoque semiológico de las palpitaciones. REVISTA DE LA FACULTAD DE MEDICINA 2014. [DOI: 10.15446/revfacmed.v62n1.43779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Sparkes J, Valaitis R, McKibbon A. A usability study of patients setting up a cardiac event loop recorder and BlackBerry gateway for remote monitoring at home. Telemed J E Health 2012; 18:484-90. [PMID: 22676379 DOI: 10.1089/tmj.2011.0230] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article reports on a usability study of remote noninvasive cardiac testing in homes. We studied the Vitaphone 3100BT (Bluetooth®) event loop recorder (Vitaphone GmbH, Mannheim, Germany) and paired BlackBerry® Curve™ 8520 smartphone (Research In Motion, Ltd., Waterloo, ON, Canada). This application requires independent device set-up by patients in their own homes following receipt by mail out of the kit (instructions plus the event loop recorder and smartphone). The case studies of five participants, each with varying experience with technology, were documented as they interacted with the devices. Participants were videotaped following written instructions as they performed a "think aloud" procedure while completing 20 device set-up tasks. Interviews provided insight into how the independent device set-up and processes could be improved. This study concluded that gender, age, and familiarity with technology seemed to influence the participants' abilities to successfully set up these devices and that sending the kit by mail appeared to be an acceptable strategy to provide remote noninvasive cardiac diagnostic services. This study provides a foundation for future research assessing usability of mobile healthcare technology.
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Affiliation(s)
- Jane Sparkes
- eHealth, McMaster University, Hamilton, Ontario, Canada.
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13
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Raviele A, Giada F, Bergfeldt L, Blanc JJ, Blomstrom-Lundqvist C, Mont L, Morgan JM, Raatikainen MJP, Steinbeck G, Viskin S, Kirchhof P, Braunschweig F, Borggrefe M, Hocini M, Bella PD, Shah DC. Management of patients with palpitations: a position paper from the European Heart Rhythm Association. Europace 2011; 13:920-34. [DOI: 10.1093/europace/eur130] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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14
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Lin SH, Liu JH, Wei J, Yin WH, Chen HH, Chiu WT. A Business Model Analysis of Telecardiology Service. Telemed J E Health 2010; 16:1067-73. [DOI: 10.1089/tmj.2010.0059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shu-Hsia Lin
- Operation Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Jorn-Hon Liu
- Superintendent Office, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Jen Wei
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Wei-Hsian Yin
- Division of Cardiology, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Hung-Hsin Chen
- Department of Business Administration, Zhejiang University, Hangzhou, China
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Hoefman E, Bindels P, van Weert H. Efficacy of diagnostic tools for detecting cardiac arrhythmias: systematic literature search. Neth Heart J 2010; 18:543-51. [PMID: 21113379 PMCID: PMC2989492 DOI: 10.1007/s12471-010-0831-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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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Affiliation(s)
- E. Hoefman
- Department of General Practice, Academic Medical Center, University of Amsterdam, 22660, 1100, DD Amsterdam, the Netherlands
| | - P.J.E. Bindels
- Department of General Practice, Erasmus MC Rotterdam, Rotterdam, the Netherlands
| | - H.C.P.M. van Weert
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Kadish AH, Reiffel JA, Clauser J, Prater S, Menard M, Kopelman H. Frequency of serious arrhythmias detected with ambulatory cardiac telemetry. Am J Cardiol 2010; 105:1313-6. [PMID: 20403485 DOI: 10.1016/j.amjcard.2009.12.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 12/14/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
Abstract
Ambulatory cardiac telemetry has been shown to be effective in establishing diagnoses in patients with suspected arrhythmias. A critical component of ambulatory telemetry is the immediate transfer of rhythm information to a central monitoring station without requiring patient action. The frequency with which potentially life-threatening events are detected using ambulatory telemetry has not previously been evaluated in a large patient population. All patients (n = 26,438) who underwent monitoring from April to December 2008 at a single service provider formed the patient population of this study. Arrhythmic events noted in these patients were defined as those requiring physician notification and those that represented potentially life-threatening arrhythmias. Of the 26,438 patients included in the study, 5,459 (21%) had arrhythmic events meeting physician notification criteria during a mean monitoring period of 21 days. Of these, 262 patients (1%) had arrhythmic events that could potentially be classified as emergent. These included 120 patients with wide complex tachycardia > or = 15 beats at > or = 120 beats/min, 100 patients with pauses > or = 6 seconds, and 42 patients with sustained heart rates <30 beats/min. An additional 704 patients (3%) had narrow complex tachycardia > or = 180 beats/min at rest. In conclusion, approximately 1% of patients who underwent ambulatory telemetry for routine clinical indications experienced life-threatening arrhythmic events over a 3-week monitoring period. Ambulatory cardiac telemetry could be potentially lifesaving in this group of patients.
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Guidelines for telematic second opinion consultation on headaches in Europe: on behalf of the European Headache Federation (EHF). J Headache Pain 2010; 11:345-8. [PMID: 20373124 PMCID: PMC3476343 DOI: 10.1007/s10194-010-0211-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 03/25/2010] [Indexed: 11/05/2022] Open
Abstract
The seeking of a second opinion is the long-established process whereby a physician or expert from the same or a similar specialty is invited to assess a clinical case in order to confirm or reject a diagnosis or treatment plan. Seeking a second opinion has become more common in recent years, and the trend is associated with significant changes in the patient-doctor relationship. Telemedicine is attractive because it is not only fast but also affordable and thus makes it possible to reach highly qualified centres and experts that would otherwise be inaccessible, being impossible, or too expensive, to reach by any surface transport. In Europe, the European Headache Federation (EHF), being able to draw on a group of headache experts covering all the European languages, is the organisation best placed to provide qualified second-opinion consultation on difficult headache cases and to develop a Headache Medical Opinion Service Centre. The provision of good quality clinical information is crucial to the formulation of a valid, expert second opinion. This preliminary step can be properly accomplished only by the primary health care provider through the furnishing of an appropriate clinical report, together with the results of all available tests, including original films of all imaging studies already performed. On receiving the EHF’s proposed standardised data collection form, properly filled in, we may be sure that we have all the relevant data necessary to formulate a valid expert second opinion. This form can be accessed electronically and downloaded from the EHF website. Once finalised, the EHF second opinion project should be treated as a pilot strategy that requires careful monitoring (for the first year at least), so that appropriate changes, as suggested by the retrospective analysis and its quality control, can be implemented.
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The Utility of Transtelephonic Electrocardiograms for Detecting Arrhythmia Recurrences after Radiofrequency Catheter Ablation for Atrial Fibrillation. J Arrhythm 2009. [DOI: 10.1016/s1880-4276(09)80011-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Oeff M, Müller A, Neuzner J, Sack S, Schwab JO, Pfeiffer D, Zugck C. [ECG telemonitoring]. Herzschrittmacherther Elektrophysiol 2008; 19:137-45. [PMID: 18956160 DOI: 10.1007/s00399-008-0012-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 07/21/2008] [Indexed: 10/19/2022]
Abstract
ECG telemonitoring is the application of single- or multichannel ECGs transmitted by telephone to the physician or an expert center. This enables the control of the health status despite the spatial separation of patient and physician. Cardiac arrhythmias, palpitations of unknown causes, the outcome of antiarrhythmic drug therapy or interventional ablation therapy can be diagnosed using ECG telemonitoring. Even asymptomatic arrhythmias, e.g. paroxysmal atrial fibrillation, may be detected. The use of a multichannel ECG facilitates the early prehospital diagnosis of an acute coronary syndrome and thus helps to optimize the chain of rescue. The telemonitoring of the ECG and additional physiological data enables the tele-care of patients with chronic heart failure. New types of implanted pacemaker or cardioverter/defibrillator devices allow telemonitoring of device data or ECG data for close control.
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Affiliation(s)
- Michael Oeff
- Chefarzt der Klinik für Innere Medizin I, Städtisches Klinikum Brandenburg GmbH, Hochstrasse 29, 14770 Brandenburg, Deutschland.
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Lewalter T. [The patient with unclear palpitations: how extensive should the diagnostic approach be?]. Herzschrittmacherther Elektrophysiol 2008; 19:155-159. [PMID: 18956162 DOI: 10.1007/s00399-008-0018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 07/27/2008] [Indexed: 05/27/2023]
Abstract
The symptom "palpitation" may be caused by a cardiac arrhythmia; however, in a significant number of events no concomitant arrhythmia can be documented. In addition, a patient complaining about palpitations can be threatened by an event leading to significant morbidity or even increased mortality (e.g., atrial fibrillation in a patient with risk factors for stroke) or, in contrast, the symptom palpitation may have no implications in terms of morbidity or prognosis (e.g., premature atrial contractions in a healthy person). This unspecific character of the symptom "palpitation" makes clear that the diagnostic approach has to be individualized: the patient with severe concomitant symptoms, hemodynamic deterioration and/or risk factors for cardiogenic thromboembolism should be thoroughly investigated to detect an underlying disease and to document an ECG during the palpitations. Those with only mild symptoms and no evidence for a cardiac disease in a non-invasive work-up can be simply followed-up.
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Affiliation(s)
- Thorsten Lewalter
- Medizinischen Klinik II, Innere Medizin mit den Schwerpunkten, Kardiologie und Internistische Intensivmedizin, St. Vincenz-Krankenhaus, Akademisches Lehrkrankenhaus, Universität Göttingen, Am Busdorf 2, 33098 Paderborn, Deutschland.
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Sulfi S, Balami D, Sekhri N, Suliman A, Kapur A, Archbold RA, Ranjadayalan K, Timmis AD. Limited clinical utility of Holter monitoring in patients with palpitations or altered consciousness: analysis of 8973 recordings in 7394 patients. Ann Noninvasive Electrocardiol 2008; 13:39-43. [PMID: 18234005 DOI: 10.1111/j.1542-474x.2007.00199.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIMS To determine the clinical utility of 24 hour Holter monitoring by measuring the frequency of candidate arrhythmias recorded during the investigation of palpitations and altered consciousness. METHODS Of 9,729 Holter recordings, reports were available in 8,973 (92.2%) performed in the 7394 patients who comprise the study group. The mean age of the study group was 66 +/- 19 years and 56.4% were women. RESULTS The most common indications were altered consciousness (41.7%) and palpitations (36.2%). Among patients with palpitations and sinus rhythm (n=2688), recordings were normal in 2247 (83.6%). Abnormalities included paroxysmal atrial fibrillation (PAF, 6.6%), narrow complex tachycardia (NCT, 2.8%) nonsustained or sustained ventricular tachycardia (NSVT/VT, 2.6%). Among patients with altered consciousness (n=3075), recordings were normal in 2589 (84.2%). Abnormalities included PAF (9.5%), NCT (2.6%), NSV/VT (0.2%), pause >2.8s (2.2%) and high degree AV block (1.3%). The diagnostic yield of Holter monitoring was particularly low in patients aged < or =50 years, of whom 93.1% had palpitations and 95.3% had altered consciousness had normal recordings. CONCLUSIONS The diagnostic utility of Holter monitoring in patients being investigated for palpitations and altered consciousness is very limited, particularly in young patients for whom alternative diagnostic methods should be considered.
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