J Am Coll Cardiol, 2007; 49:1951-1956, doi:10.1016/j.jacc.2007.02.036 (Published online 30 April 2007). © 2007 by the American College of Cardiology Foundation

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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Recurrent Unexplained Palpitations (RUP) Study

Comparison of Implantable Loop Recorder Versus Conventional Diagnostic Strategy

Franco Giada, MD^_*, Michele Gulizia, MD, Maura Francese, MD, Francesco Croci, MD, Lucio Santangelo, MD, Maurizio Santomauro, MD^||, Eraldo Occhetta, MD^¶, Carlo Menozzi, MD^# and Antonio Raviele, MD^_*,_*

^_* Cardiovascular Department, Ospedale Umberto I, Mestre-Venice, Venice, Italy
Division of Cardiology, Ospedale S. Luigi-S. Currò, Catania, Italy
Arrhythmologic Unit, Ospedali Riuniti, Lavagna, Italy
Cardiology Department, 2° Naples University, Naples, Italy
^|| Division of Cardiology, Federico II University, Naples, Italy
^¶ Division of Cardiology, Ospedale Maggiore della Carità, Novara, Italy
^# Division of Cardiology, Reggio Emilia, Reggio Emilia, Italy.

Manuscript received November 6, 2006; revised manuscript received January 30, 2007, accepted February 5, 2007.

^_* Reprint requests and correspondence: Dr. Antonio Raviele, Cardiovascular Department, Umberto I Hospital, Via Circonvallazione 50, 30170 Mestre-Venice, Italy. (Email: araviele{at}tin.it).

Objectives: The aim of the study was to compare the diagnostic yield and the costs of implantable loop recorder (ILR) with those of the conventional strategy in patients with unexplained palpitations.

Background: In patients with unexplained palpitations, especially in those with infrequent symptoms, the conventional strategy, including short-term ambulatory electrocardiogram (ECG) monitoring and electrophysiological study, sometimes fails to establish a diagnosis.

Methods: We studied 50 patients with infrequent (1 episode/month), sustained (>1 min) palpitations. Before enrollment, patients had a negative initial evaluation, including history, physical examination, and ECG. Patients were randomized either to conventional strategy (24-h Holter recording, a 4-week period of ambulatory ECG monitoring with an external recorder, and electrophysiological study) (n = 24) or to ILR implantation with 1-year monitoring (n = 26). Hospital costs of the 2 strategies were calculated.

Results: A diagnosis was obtained in 5 patients in the conventional strategy group, and in 19 subjects in the ILR group (21% vs. 73%, p < 0.001). Despite the higher initial cost, the cost per diagnosis in the ILR group was lower than in the conventional strategy group (3,056 ± 363 vs. 6,768 ± 6,672, p = 0.012).

Conclusions: In subjects without severe heart disease and with infrequent palpitations, ILR is a safe and more cost-effective diagnostic approach than conventional strategy.

Abbreviations and Acronyms   AF = atrial fibrillation   AVB = atrioventricular block   EPS = electrophysiological study   ER = external recorder   ICER = incremental cost-effectiveness ratio   ILR = implantable loop recorder   SB = sinus bradycardia   SHD = structural heart disease   ST = sinus tachycardia   SVT = supraventricular tachycardia

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