Diagnostic Yield of an Ambulatory Patch Monitor in Unexplained Emergency Department Syncope: A Pilot Study (PATCH-ED) (PATCH-ED)
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|ClinicalTrials.gov Identifier: NCT02683174|
Recruitment Status : Completed
First Posted : February 17, 2016
Results First Posted : December 3, 2019
Last Update Posted : December 3, 2019
Syncope is a common Emergency Department (ED) presentation but the underlying diagnosis is not apparent in 60% of patients after assessment and serious adverse event rate is 7% at one month with most having acute cardiovascular events, also more likely to be unexplained after ED assessment. Many cardiovascular events are due to arrhythmia, difficult for clinicians to diagnose, as examination and Electrocardiogram (ECG) findings may both be normal and symptoms have resolved by the time the patient gets to the ED. Currently establishing a cardiac arrhythmia as the cause of syncope rests on correlating the arrhythmia with symptoms using monitoring devices such as Holter but these all have significant drawbacks. The clinical challenge in the ED is therefore to identify the moderate and high-risk patients and refer them for further investigation and monitoring if appropriate. The logistics of arranging follow up within a timely period of the patient's ED visit is often problematic for a variety of reasons including availability of timely specialty outpatient appointments, a lack of consensus of the specialty to whom the syncope patient should be referred (cardiology, medicine, neurology, general practice) and availability of Holter and other monitoring devices. For this reason most high and medium risk patients are admitted to hospital.
Previous syncope clinical decision rules have not been well adopted due to their lack of sensitivity and specificity probably due to the varied and heterogeneous nature of potentially serious causes. However, the majority of patients with syncope have no serious underlying pathology and do not require hospitalisation. Rather than continued attempts at risk stratification of outcome based on presentation, more research is required into how we can better improve diagnosis and therefore treatment in order to provide improved patient benefit. We believe that ambulatory patch monitoring will allow better and earlier arrhythmia detection and plan to assess the ability of a 14-day ambulatory patch to detect serious arrhythmic outcomes at 90 days.
|Condition or disease||Intervention/treatment||Phase|
|Syncope||Device: Novel ambulatory patch (ZIO® XT Patch) Biological: BNP and hs-troponin I at 0 and 3 hours post ED attendance||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||86 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Diagnostic Yield of an Ambulatory Patch Monitor in Emergency Department Syncope Patients Unexplained After Emergency Department Evaluation: A Pilot Study (PATCH-ED)|
|Study Start Date :||November 1, 2015|
|Actual Primary Completion Date :||June 13, 2017|
|Actual Study Completion Date :||September 13, 2017|
Experimental: Single study arm
All enrolled patients will be fitted with a novel ambulatory patch (ZIO®Patch), which continuously records heartbeats for up to 14 days. Brain natriuretic peptide (BNP) and hs-troponin I at 0 and 3 hours post ED attendance
Device: Novel ambulatory patch (ZIO® XT Patch)
All enrolled patients will be fitted with a novel ambulatory patch (ZIO® XT Patch)
Biological: BNP and hs-troponin I at 0 and 3 hours post ED attendance
All patients will have quantification of hs-troponin I (ARCHITECTSTAT high-sensitivity troponin I assay) and BNP (ALERE TRIAGE point-of-care BNP test; ALERE, San Diego, USA; www.alere.co.uk) at 0 and 3 hours post ED attendance.
- Number of Ambulatory Patch Monitor Participants Having Significant Symptomatic Arrhythmia [ Time Frame: 90 days ]
Significant arrhythmia will be defined as:
- Non-symptomatic ventricular tachycardia < 30 seconds,
- Symptomatic sinus bradycardia < 60 beats/minute (but >40 or less than 30 seconds),
- Asymptomatic sinus bradycardia < 40 beats/minute,
- Sick sinus syndrome with alternating sinus bradycardia and tachycardia,
- Sinus pause > 3 seconds (but less than 6 seconds),
- Symptomatic Mobitz type I atrioventricular heart block,
- Junctional/idioventricular rhythm,
- Symptomatic supraventricular tachycardia with rate > 100/minute,
- Symptomatic atrial flutter/fibrillation with ventricular rate >100/min,
- Symptomatic atrial flutter/fibrillation with ventricular rate <60/min
Arrhythmias will also be defined as symptomatic (i.e. concurrent light-headedness/dizziness, syncope/presyncope with arrhythmia) or asymptomatic.
- Median Time to Detection of Significant Symptomatic Arrhythmia [ Time Frame: 90 days ]Median time to detection of significant symptomatic arrhythmia by ambulatory patch monitor
- Number of Participants With Arrhythmia [ Time Frame: 90 days ]Prevalence of arrhythmia including serious significant arrhythmia, significant arrhythmia and symptomatic arrhythmia in ED syncope patients unexplained after ED evaluation.
- Number of Participants Who Agreed or Strongly Agreed That the Patch Monitor Was Easy to Use. [ Time Frame: 90 days ]Number of participants who agreed or strongly agreed that the patch monitor was easy to use. Patient patch satisfaction (postal questionnaire).
- Median Device Wear Time [ Time Frame: 14 days ]Patch compliance described by median device wear time
- Number of Participants With Significant Arrhythmia Requiring Referral. [ Time Frame: 90 days ]Number of participants with significant underlying arrhythmic pathology on ambulatory patch monitoring requiring referral.
- Number of Participants With All Cause Serious Outcome [ Time Frame: 90 days ]
All cause serious outcome will be a composite of:
- All cause death,
Major adverse cardiac events [MACE]
- Myocardial infarction ,
- Significant arrhythmia ,
- Significant Structural Heart Disease ,
- Positive Electrophysiology Study Findings 
- Permanent pacemaker or defibrillator placement,
- Coronary artery bypass graft or coronary artery stent,
- Cardiac valve surgery,
- Elective cardioversion in the absence of objective evidence that tachyarrhythmia is responsible for the syncope,
- Balloon-pump insertion,
- Heart transplant,
- Initiation of anti-arrhythmia medical therapy,
- Ventricular assist device
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02683174
|Royal Infirmary of Edinburgh|
|Edinburgh, Midlothian, United Kingdom, EH16 4SA|
|Principal Investigator:||Matthew J Reed, MA FCEM MD||NHS Lothian|