{
  "abstract": "Background: Capturing an electrocardiogram (ECG) during transient symptoms remains challenging in emergency department (ED) patients with palpitations. Following the IPED trial, a smartphone-based ambulatory ECG event recorder pathway was integrated into NHS care. We evaluated this service over five years, assessing diagnostic yield, management, one-year outcomes and predictors of cardiac arrhythmia. Methods: Single-centre service evaluation of consecutive patients referred with palpitations to a smartphone-based ambulatory ECG event recorder clinic between 24th July 2019 and 24th July 2024. Patients underwent event-triggered ECG monitoring using the single-lead Kardia Mobile (AliveCor, Inc.) or their own smartwatch with ECG capability. Clinical characteristics, rhythm recordings, investigations, one-year outcomes and management changes were recorded. Multivariable logistic regression identified independent predictors of one-year cardiac arrhythmia diagnosis. Results: 1750 patients attended the clinic, mean age 44.3 +/- 16.1 years, 58.2% female. 1176 patients (67.2%) underwent monitoring with a cardiac arrhythmia directly captured in 67 patients (5.7% of monitored), including atrial fibrillation (n=39), supraventricular tachycardia (13), atrial flutter (9), atrial tachycardia (5) and ventricular tachycardia (1). By one year, 84 (7.1%) who underwent monitoring received a cardiac diagnosis with 79.8% (67/84) established directly via clinic monitoring. Across the entire cohort (n=1750), 114 (6.5%) had a cardiac cause at one year, 1472 (84.2%) had non-cardiac aetiology and 1569 (89.1%) were discharged back to primary care. Medication changes were initiated in 106 patients (6.1%). Independent predictors of a one-year cardiac diagnosis were increasing age (aOR 1.04 per 1-year increase), prior atrial fibrillation/flutter (aOR 5.57) and a presenting symptom of irregular beating (aOR 2.65). Conclusion: Our service provides an effective model for evaluating ED patients with palpitations. Over five years the service reliably detected actionable cardiac arrhythmias while safely discharging nearly 90% of patients to primary care. Clinical characteristics may guide patient selection to maximise clinic efficiency.",
  "abstract_shown": true,
  "affiliations": [
    "Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK; Acute Care Edinburgh, Usher Institute, University of Edinburg"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 15,
  "authors": [
    {
      "name": "C. Morran"
    },
    {
      "name": "P. Srinivasan"
    },
    {
      "name": "R. Andrew"
    },
    {
      "name": "E. A. Pow"
    },
    {
      "name": "L. Padovani"
    },
    {
      "name": "Y. Thackray"
    },
    {
      "name": "R. Murphy"
    },
    {
      "name": "G. Zangana"
    },
    {
      "name": "S. Krupej"
    },
    {
      "name": "M. I'Anson"
    },
    {
      "name": "L. Findlay"
    },
    {
      "name": "J. Millar"
    },
    {
      "name": "F. Watts"
    },
    {
      "name": "M. Moni"
    },
    {
      "affs": [
        0
      ],
      "name": "M. J. Reed"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dr0xbz9k1xekq.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.11.05.26367104",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.11.05.26367104v1.full",
  "id": "dr0xbz9k1xekq",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.11.05.26367104v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "emergency medicine"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.11.05.26367104v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-05",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/dr0xbz9k1xekq.ris",
  "sources": [
    {
      "first_seen": "2026-11-10T00:22:41Z",
      "native_id": "10.64898/2026.11.05.26367104",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.11.05.26367104v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:emergency medicine",
      "subfield": "general"
    }
  ],
  "title": "Diagnosing a cardiac cause for palpitations: Five-year service evaluation of a smartphone ambulatory ECG pathway for Emergency Department patients.",
  "title_text": "Diagnosing a cardiac cause for palpitations: Five-year service evaluation of a smartphone ambulatory ECG pathway for Emergency Department patients.",
  "type": "preprint",
  "updated_at": "2026-11-10T00:22:41Z",
  "url": "https://research.draconitic.com/paper/dr0xbz9k1xekq",
  "venue": "medRxiv",
  "versions": []
}