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Table 8.6

When to Admit the Patient with Palpitation

Diagnostic purposes

Severe structural heart disease (e.g. severe valve disease, complex congenital heart disease, cardiomyopathy, severely impaired left ventricular systolic function (ejection fraction <35%)), suspected or ascertained

Primary electrical heart disease (channelopathy), suspected or ascertained

Family history of sudden death

Need to perform electrophysiological study, invasive investigations or in-hospital telemetric monitoring

Therapeutic purposes

Bradyarrhythmias requiring implantation of pacemaker

Cardiac device malfunction not rectifiable by reprogramming

Ventricular tachyarrhythmias requiring immediate interruption and/or implantable cardoverter-defibrillator (ICD) implantation or catheter ablation

Supraventricular tachycardias requiring interruption immediately or in a short time, or catheter ablation

Presence of heart failure or other symptoms of haemodynamic compromise

Severe structural heart diseases requiring surgery or interventional procedures

Severe systemic causes (see Table 8.5)

Severe psychotic decompensation

Source: Raviele A, Giada F, Bergfeldt L, et al. (2011) Management of patients with palpitations: a position paper from the European Heart Rhythm Association. Europace 13, 920–934. Reproduced with permission of Oxford University Press.