The contribution of 24-hour ambulatory ECG monitoring in a general medical unit.

Twenty-four hour ambulatory ECG records were obtained from 163 patients attending a general medical unit of a district general hospital. The main indications for recording were palpitations, syncope and dizziness and 262 tapes were suitable for analysis. Problems and benefits of the system were discussed. Abnormalities detected were supraventricular tachycardia, ventricular tachycardia, atrial fibrillation, intermittent heart block, sinoatrial disease and pacemaker malfunction. Sixty-one patients were reassured and in 78 patients an alteration in drug regime was advised with clinical improvement in 63 cases. Vertebrobasilar insufficiency was diagnosed in 14 patients, 4 patients were referred for further cardiac investigations, 4 required insertion or replacement of a pacemaker, 1 was referred for psychiatric opinion, and 1 patient died. Selected 24-hour ambulatory ECG monitoring in a district general hospital provides a valuable service for investigation of symptoms that may be caused by cardiac arrhythmias. The question of local or centralised analysis of recordings should be decided on the grounds of time and staff available and the capital cost of equipment.