From the Guidelines
The diagnostic workup for palpitations should start with a thorough clinical history and physical examination to identify the pattern and characteristics of the palpitations, as well as any underlying heart disease or other potential causes 1.
Key Components of Diagnostic Workup
- A 12-lead ECG should be recorded to evaluate for signs of pre-excitation, atrioventricular (AV) dissociation, or other abnormalities that may indicate the underlying cause of the palpitations 1.
- Ambulatory monitoring, such as a 24-hour Holter recording or an event monitor, may be used to capture episodes of palpitations and determine the underlying rhythm 1.
- Echocardiography should be considered to exclude structural heart disease, particularly in patients with sustained supraventricular tachycardia (SVT) 1.
- Invasive electrophysiological testing may be necessary in some cases to diagnose and treat underlying arrhythmias, such as AVRT or AVNRT 1.
Importance of Accurate Diagnosis
Accurate diagnosis of the underlying cause of palpitations is crucial to guide treatment and prevent potential complications, such as tachycardia-mediated cardiomyopathy or sudden cardiac death 1.
Additional Considerations
- Vagal maneuvers may be used to terminate episodes of SVT and help diagnose re-entrant tachycardias involving AV nodal tissue 1.
- Referral to a cardiac arrhythmia specialist may be necessary for patients with complex or refractory arrhythmias, or those who require invasive electrophysiological testing or catheter ablation 1.
From the Research
Diagnostic Workup for Palpitations
The diagnostic workup for palpitations typically involves a combination of the following steps:
- History and physical examination to identify potential causes and guide further investigations 2, 3, 4, 5
- 12-lead electrocardiography (ECG) to evaluate cardiac rhythm and structure 2, 4, 5
- Ambulatory electrocardiographic monitoring, such as Holter monitoring, to correlate symptoms with ECG recordings 2, 6, 3, 4, 5
- Echocardiography to evaluate cardiac structure and function 2, 3
- Electrophysiology studies to evaluate cardiac conduction and rhythm disorders 2, 3, 4
- Other investigations, such as event monitors, transtelephonic electrocardiographic monitors, and treadmill exercise stress tests, may also be used in specific cases 3
Factors Influencing Diagnostic Workup
The intensity and extent of the diagnostic workup may be influenced by: