Predictors of arrhythmic events during second day monitoring in patients with normal first day Holter recordings.

BACKGROUND

The diagnostic yield of Holter monitoring in patients with syncope is variably reported to be between 6%-20%. This study was done to define predictors of arrhythmic events during the second day of Holter monitoring in patients whose first day Holter recording was normal.

METHODS AND

RESULTS

Two serial 24-hour Holter recordings were obtained in a consecutive series of 100 patients (49 patients with unexplained syncope and/or pre-syncope and 51 patients with palpitation). The age of patients was 53.4 +/- 16.9 years and 51 were men. Seventy-six patients had underlying heart disease. Main electrocardiographic findings were found in 40 (40%) patients including non-sustained ventricular tachycardia in 19, sinus pause in 13, symptomatic bradycardia in 5, paroxysmal atrial fibrillation in 4, sustained supraventricular tachycardia in 2, and Mobitz type II second-degree atrioventricular block in 3 patients. Twenty-seven (27%) patients had 33 main electrocardiographic findings during the first day and 13 out of the remaining 73 patients (17.8%) had it during the second day of Holter recording. Presenting symptom (syncope/pre-syncope), age > 65 years, and male gender were significantly associated with increased likelihood of main electrocardiographic findings during the second day of Holter monitoring (p = 006, 0.023, and 0.024, respectively). The risk of main electrocardiographic findings ranged from 5% in patients with one or no predictor to 35% in those with > or = 2 predictors (OR = 9.95, 95% CI = 2.01-49.2, p = 0.002).

CONCLUSIONS

Presenting symptom (syncope/pre-syncope), age > 65 years, and male gender increased the likelihood of main electrocardiographic findings during the second day of Holter monitoring.