Introduction Atrial fibrillation (AF) is a global public health priority. An unsolved problem is how to detect paroxysmal AF. Patients presenting with palpitations are usually monitored for a short period of time with conventional 24 hour Holter monitor or 72 hours cardiac memo. As a result, it is likely that AF is being routinely underdiagnosed and undertreated. This service evaluation reviewed the proportion of patients amongst those who are investigated for palpitations/pre-syncope/syncope by the Cardiology Department in Queen Alexandra hospital (CQAH) with a 24 hours Holter monitor or cardiac memo who have evidence of AF.
Methods Retrospective review of all patients who were investigated with either a 24 hours Holter monitor or 72 hours cardiac memo during August 2019. Clinic letters and discharge summaries were reviewed to assess reason for investigations, findings and outcomes. If a diagnosis of AF, paroxysmal AF or atrial flutter was made, management decision and subsequent anticoagulation was reviewed.
Results A total of 232 patients were assessed with 24 hours Holter (n=122) monitor and Cardiac memo (n=108). Average age 65 years (5-94). In 5% of cases (12/232) no documentation of results was found. 5% (10/220) had new diagnosis of AF.
60% (72/122) of patients investigated with a 24 hours Holter monitor for palpitation (18/122), pre-syncope (5/122) and syncope (15/122) were in sinus rhythm (SR) +/- ectopics. No patients with palpitation or pre-syncope had AF. 4/15 patients with syncope had a new diagnosis of AF (2) or supraventricular tachycardia (2). 34% (42/122) of Holter monitor were done as a result of a documented arrhythmia, 18/42 of which had known AF. 21% (26/122) of Holter monitor were used to investigate TIA/Stroke, 3/26 had new diagnosis of AF.
70% (75/108) of patients investigated with a Cardiac Memo for palpitations (28/108), pre-syncope (13/108) and syncope (15/108) were in SR +/- ectopics. 3/28 with palpitations, 1/13 with pre-syncope, 1/15 with syncope group had new AF. 2/15 with syncope who were in SR had a reveal device implanted subsequently. 34% (37/108) were investigated due to TIA/Stroke, all of which were in SR.
Conclusion The number of patients diagnosed with significant cardiac arrhythmia, for example AF, as a result of conventional 24 hours tape and cardiac memo is low even if patients present with symptoms of palpitations, pre-syncope and syncope.
As a result of this service evaluation we have applied for a £20.000 grant as part of a ‘NHS Joint Working Project’ to introduce novel, prolonged and home-based ECG monitoring to the department. Patients who are referred to CQAH and require investigation of symptoms of palpitation, pre-syncope and syncope will be offered ECG monitoring over up to 3 months with a KardiaMobile 6 lead ECG (by AliveCor) as an alternative to conventional methods described above. A comparison of identification of cardiac arrhythmia, in particularly AF and subsequent management change, will be made.
Conflict of Interest Nil
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.