Introduction: Palpitations are a common reason for referral to cardiology. Correlation of patient symptoms with rhythm and thus diagnosis can be difficult. Conventional ambulatory monitoring often fails to yield a symptom-rhythm correlation. The MiCor A100 (MiTAC Europe, W Sussex, UK) is a CE-marked wearable patient-activated lead I ECG capable of recording 30 seconds per activation. It has the potential for use in patients with infrequent symptoms but its use is not widely established. We assessed its diagnostic utility in the initial investigation of palpitations.
Method: At our centre, 50 patients referred for investigation of palpitations or presyncope were issued with a MiCor device and trained how to use it. Patients were instructed to activate the device at the time of symptoms. Exclusion criteria included syncope and inability to use the device. All ECG recordings were uploaded to a database and reviewed by a cardiologist.
Results: Fifty patients (male n=18, female n=32, age 10–86) were issued with a MiCor device. The median time to diagnosis was 15 days (1–211). Forty-six patients submitted symptomatic recordings. One patient’s recording was uninterpretable. Four patients did not return their device. A symptom-rhythm correlation was achieved in 45/46 (98%). Diagnoses made from analysis of downloaded recordings at the time of symptoms were as follows: sinus rhythm 23 (51%), sinus tachycardia eight (18%), ventricular ectopics four (9%), supraventricular tachycardia four (9%) and atrial fibrillation six (13%).
Conclusion: The MiCor device allowed a symptom-rhythm correlation in 98% of patients. The vast majority of patients who returned the device had no significant dysrhythmia and were reassured without the need for further investigation or treatment. Use of the MiCor device allowed accurate detection of arrhythmias and facilitated prompt commencement of appropriate therapy (e.g. anticoagulation) or referral to an electrophysiologist where appropriate. Our results support the use of this device in the initial investigation of palpitations in the absence of syncope. It could be used in a primary care setting for early diagnosis and to prevent unnecessary referrals to secondary care and may be used as an alternative diagnostic device in patients who do not have access to smartphone technology.
