Introduction: Palpitations are a common symptom that lead patients to consultation with healthcare providers and cardiology services. Achieving the diagnostic and therapeutic management of palpitations is challenging as palpitations are caused by wide range of different conditions and there are broad differential diagnoses. Electrocardiography (ECG) is a crucial investigation to get the definitive diagnosis, including symptom-rhythm correlation. This often proves difficult because palpitations are usually transient. Because of limited monitoring period, currently available non-invasive investigations such as 24 hr Holter and cardiac event recorders often fail to catch the palpitation episodes and hence yield is low. New modern technology devices such as Zenicor ECG reduce these challenges in getting the diagnosis in those presenting with palpitations.
Methods: Zenicor ECG is a small handheld device which is given to patients to take home. Via both thumbs, it registers the bipolar extremity lead 1 ECG for 30 seconds. After each registration the recording is transmitted by the patient via the built-in mobile device to a web based central database and we have access to the patients recording. Our centre is the only cardiology department in the UK using these devices for the investigation of palpitations. The inclusion criteria are patients presenting with palpitations which occur less than once/ week. Patients were asked to perform handheld ECG for 30 seconds with Zenicor ECG while having palpitations.
Results: From May 2018 to April 2019, 60 patients were investigated using the Zenicor ECG. The age range was 19–86 years old. The average monitoring period was 14 days (78.3%). Nine patients (15%) were monitored up to 30 days and 2 patients (3.3%) were monitored up to 42 days. Patients were able to record ECGs whenever they had symptoms, and these were reviewed regularly. 93.7% of total tracings were of good quality. Atrial fibrillation (AF) was diagnosed in 4 patients (6.7%). Three patients (5%) were diagnosed with supraventricular tachycardia (SVT). Three patients (5%) had isolated ventricular ectopic beats or runs of ectopics. The palpitation episodes of 12 patients (20%) correlated with sinus tachycardia. Among the patients diagnosed with AF, one patient was newly diagnosed, and the other 3 patients had a possible history of paroxysmal AF but they remained asymptomatic for years. However, palpitations recurred recently, and they were unable to be detected with Holter or cardiac event recorder. All three SVT patients were newly diagnosed and all of them were having palpitations for years but failed to catch the episodes because palpitations happened seldomly and self-aborted before ECG diagnosis. All patients who were diagnosed with AF or SVT received the appropriate treatments, most importantly anticoagulation for AF. The other remaining patients were confidently reassured that there were no life threatening or dangerous arrhythmia during palpitations as we were able to get the symptom-rhythm correlation which is the corner stone in investigation of palpitations.
Conclusion: We successfully used the Zenicor ECG to detect a significant number of arrhythmias which may have otherwise not been captured on traditional ECG monitoring devices. These patients then received a diagnosis and appropriate management such as anticoagulation for AF. Using modern digital technology may help improve cardiac diagnostics. The Zenicor ECG is simple, user friendly and suitable for prolonged monitoring.