Can Physical Examination and Resting Electrocardiography Direct the Use of Echocardiography in Patients with Palpitations?

Background: Most patients referred for specialist assessment due to palpitations do not have significant arrhythmias; nonetheless, transthoracic echocardiography (TTE) is routinely requested and is often normal. This study sought to determine whether physical examination and resting electrocardiogram (ECG) findings could predict TTE findings. Methods: In this single-center study, we first identified all patients referred from primary care due to palpitations. We excluded patients with a history of heart disease or arrhythmia (as TTE would be indicated in such cases). We extracted data from patients’ records on baseline demographics, physical examination, ECG, and TTE findings. Results: Over an 18-month period, 1809 patients were referred to our electrophysiology clinics, of whom 250 were for evaluation of palpitations without a history of cardiovascular disease or arrhythmias. A normal physical examination and a normal resting 12-lead ECG both increased the likelihood of a normal echocardiogram; of the 78 patients with normal examination and ECG, 70 (90%) had a normal echocardiogram; the abnormal cases were predominantly left atrial dilatation. No patients had ventricular dysfunction or moderate/severe heart valve disease. Conclusions: Among patients referred due to palpitations without a history of cardiovascular disease or arrhythmia, a normal physical examination and resting ECG predict the absence of ventricular dysfunction or significant valvular heart disease. Further studies should explore the role of abbreviated echocardiography protocols, which may thus increase departmental efficiency.