Article Text

Optimal duration and predictors of diagnostic utility of patient-activated ambulatory ECG monitoring
  1. Eugene S J Tan,
  2. Swee-Chong Seow,
  3. Pipin Kojodjojo,
  4. Devinder Singh,
  5. Wee Tiong Yeo,
  6. Toon Wei Lim
  1. Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
  1. Correspondence to Dr Eugene S J Tan, National University Heart Centre Singapore, Singapore 119074, Singapore; eugene_sj_tan{at}


Objective We studied the optimal duration of ambulatory event monitors for symptomatic patients and the predictors of detected events.

Methods Patients with palpitations or dizziness received a patient-activated handheld event monitor which records 30 s single-lead ECG strips. Patients were monitored in an ambulatory setting for a range of 1–4 weeks and ECG strips interpreted by five independent electrophysiologists. Event pick-up rates and clinical covariates were analysed.

Results Of 335 consecutive adults (age 50±16 years, 58% female) with palpitations (94%) and dizziness (25%) monitored, 286 patients (85%) reported events, and clinically significant events were detected in 86 (26%) patients. Of these 86 patients, 26% had ≥2 significant events, and 73% had events detected in the first 3 days. No significant events were detected after 12 days. The most common ECG abnormalities detected were premature ventricular ectopy (38%), premature atrial ectopy (37%) and atrial fibrillation (AF)/atrial flutter (34%). A history of AF (adjusted OR (AOR) 4.2, 95% CI 1.1 to 15.8), previous arrhythmia (AOR 2.8, 95% CI 2.3 to 5.9) and previous abnormal ambulatory monitoring (AOR 3.4, 95% CI 1.0 to 9.4) were associated with detection of clinically significant events. Patients older than 50 years were 82% more likely to have a clinically significant event (OR 1.8, 95% CI 1.3 to 3.6).

Conclusion Patient-activated ambulatory event monitoring for 7 days may be sufficient in the diagnosis of symptomatic patients as significant events first detected beyond 10 days were rare. Patients with a history of AF, arrhythmia or previous abnormal ambulatory monitoring may require even shorter monitoring periods.

  • Palpitations
  • Ambulatory event monitoring
  • ECG

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  • Contributors All the coauthors listed in this manuscript fulfil criteria of authorship. ESJT contributed to the planning, data analysis, interpretation of data, reporting and writing of the manuscript. SCS, PK, DS and WTY contributed to the conduction of the study, interpretation of data and review of the manuscript. TWL contributed to the planning, conduction of study, interpretation of data and review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethics approval was obtained from the National Healthcare Group Domain Specific Review Board (Reference number 2015/00689).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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