Comparison of the diagnostic yield of Holter versus transtelephonic monitoring.

OBJECTIVE

To compare the diagnostic yield of transtelephonic monitoring (TTM) with Holter monitoring in patients presenting possibly arrhythmogenic symptoms.

DESIGN

A prospective comparison of Holter monitoring with TTM performed sequentially in all subjects.

SETTING

Tertiary arrhythmia clinic at Hôpital du Sacré-Coeur de Montréal, Montréal, Québec.

PATIENTS: One hundred consecutive patients (34 men and 66 women, mean +/- SD age 55 +/- 16 years) presenting over a two-year period for diagnosis of intermittent palpitations and/or syncope/dizziness.

INTERVENTIONS: Subjects first underwent 24 h Holter monitoring and then were provided with TTM for 25 +/- 13 days, with instructions to record during symptomatic episodes and subsequently to transmit the recording at their convenience.

MAIN

RESULTS

Holter monitoring documented arrhythmia in 30 patients whereas TTM identified arrhythmia in 21. TTM was most useful in excluding arrhythmia during symptoms (34 patients) versus Holter (two patients). Neither method was useful in diagnosing syncope. Frequency of occurrence of palpitations did not predict which method would most likely yield a diagnosis but palpitations lasting longer than 2 mins were likely to be diagnosed by TTM.

CONCLUSIONS

Holter and TTM are complementary studies whose combined use increases the diagnostic yield of arrhythmia. Further, TTM is of greatest use in excluding arrhythmia during intermittent symptoms.