1. The document discusses using direct access arrhythmia monitoring services in primary care to investigate palpitations, rather than routine referral to cardiology. 2. A 29 month study of 239 patients in the Scottish Highlands found that direct access to Holter monitoring or event recorders identified underlying arrhythmias in 54% of cases and found nothing abnormal in 42% of cases. 3. The study suggests direct access arrhythmia monitoring can effectively triage low risk palpitation patients and may help address capacity issues, while still providing safe outcomes.

1. Can most “specialist” cardiac investigations be done in primary care? Steve Leslie Consultant Cardiologist (NHS Highland) Arrhythmia monitoring

8. 1. Normal ECG [email_address]

9. Brugada [email_address]

10. Wolff-Parkinson-White Syndrome [email_address]

11. Hypertrophic Cardiomyopathy [email_address]

13. AV nodal re-entrant tachycardia P

14. Atrial Fibrillation

15. Holter monitoring (24hrs) Most of use if symptomatic during study May detect asymptomatic abnormalities

16. Cardiomemo / King of Heart / Event recorder (patient activated device) Infrequent symptoms which have duration >few minutes and are reasonably tolerated

17. Implantable Loop Recorder REVEAL device Event recorder £75 (~£600 per device) Reveal £1500

23. Outcomes

27. A tale of two hearts

31. Event recorders

32. Thank you