Open AccessLimited Clinical Utility of Holter Monitoring in Patients with Palpitations or Altered Consciousness: Analysis of 8973 Recordings in 7394 Patients
Author(s) -
Sulfi Sreekumar,
Balami Dauda,
Sekhri Neha,
Suliman Abdel,
Kapur Akhil,
Archbold R. Andrew,
Ranjadayalan Kulasegaram,
Timmis Adam D.
Publication year - 2008
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/j.1542-474x.2007.00199.x
Subject(s) - palpitations , medicine , cardiology , ventricular tachycardia , anesthesia , electrocardiography , atrial fibrillation , sinus tachycardia , sinus rhythm
Aims: To determine the clinical utility of 24 hour Holter monitoring by measuring the frequency of candidate arrhythmias recorded during the investigation of palpitations and altered consciousness. Methods: Of 9,729 Holter recordings, reports were available in 8,973 (92.2%) performed in the 7394 patients who comprise the study group. The mean age of the study group was 66 ± 19 years and 56.4% were women. Results: The most common indications were altered consciousness (41.7%) and palpitations (36.2%). Among patients with palpitations and sinus rhythm (n=2688), recordings were normal in 2247 (83.6%). Abnormalities included paroxysmal atrial fibrillation (PAF, 6.6%), narrow complex tachycardia (NCT, 2.8%) nonsustained or sustained ventricular tachycardia (NSVT/VT, 2.6%). Among patients with altered consciousness (n=3075), recordings were normal in 2589 (84.2%). Abnormalities included PAF (9.5%), NCT (2.6%), NSV/VT (0.2%), pause >2.8s (2.2%) and high degree AV block (1.3%). The diagnostic yield of Holter monitoring was particularly low in patients aged ≤50 years, of whom 93.1% had palpitations and 95.3% had altered consciousness had normal recordings. Conclusions: The diagnostic utility of Holter monitoring in patients being investigated for palpitations and altered consciousness is very limited, particularly in young patients for whom alternative diagnostic methods should be considered.