Smartphone boosts symptomatic rhythm detection rate after palpitations, presyncope: IPED


  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For patients presenting with unexplained palpitations and/or presyncope to the emergency department (ED), a smartphone-based ECG event recorder (Kardia; AliveCor, San Francisco, USA) detected symptomatic rhythms at 5 times the rate of usual care.
  • Authors: “safe, non-invasive and easy to use smartphone-based event recorder should be considered part of ongoing care" for patients with this presentation.

Why this matters

  • Arrhythmia contributing to presyncope is rarely documented during initial ED presentation.

Key results

  • Intervention vs control: 
    • Symptomatic rhythm detection rate: 55.6% vs 9.5%; risk ratio (RR), 5.9; P<.0001.>
    • Symptomatic arrhythmia detection rate: 8.9% vs 0.9%; RR, 10.3; P=.006.
    • Mean time to symptomatic rhythm detection: 9.5 vs 42.9 days; P<.0001.>
    • Mean time to symptomatic arrhythmia detection: 9.9 vs 48.0 days; P=.0004.

Study design

  • Multicenter randomized controlled IPED (Investigation of Palpitations in the ED) trial (n=243).
  • Adults presenting to 10 UK EDs with palpitations and/or presyncope were randomly assigned to standard care plus smartphone event recorder vs standard care alone.
  • Triggered by patient during palpitations or presyncope, recorder captures and transmits 30-second ECG.
  • Outcome: 90-day symptomatic rhythm detection rate.
  • Funding: Chest, Heart and Stroke Scotland; British Heart Foundation.

Limitations

  • Central ECG reading service in this study may not be available at other centers.

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