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Observational Study
. 2014 Apr 1:14:41.
doi: 10.1186/1471-2261-14-41.

Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmias

Tijn Hendrikx  1 , Mårten Rosenqvist, Per Wester, Herbert Sandström, Rolf Hörnsten
Affiliations
Observational Study

Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmias

Tijn Hendrikx et al. BMC Cardiovasc Disord. .

Abstract

Background: Many patients report symptoms of palpitations or dizziness/presyncope. These patients are often referred for 24-hour Holter ECG, although the sensitivity for detecting relevant arrhythmias is comparatively low. Intermittent short ECG recording over a longer time period might be a convenient and more sensitive alternative. The objective of this study is to compare the efficacy of 24-hour Holter ECG with intermittent short ECG recording over four weeks to detect relevant arrhythmias in patients with palpitations or dizziness/presyncope.

Design: prospective, observational, cross-sectional study.

Setting: Clinical Physiology, University Hospital.

Patients: 108 consecutive patients referred for ambiguous palpitations or dizziness/presyncope.

Interventions: All individuals underwent a 24-hour Holter ECG and additionally registered 30-second handheld ECG (Zenicor EKG® thumb) recordings at home, twice daily and when having cardiac symptoms, during 28 days.

Main outcome measures: Significant arrhythmias: atrial fibrillation (AF), paroxysmal supraventricular tachycardia (PSVT), atrioventricular (AV) block II-III, sinus arrest (SA), wide complex tachycardia (WCT).

Results: 95 patients, 42 men and 53 women with a mean age of 54.1 years, completed registrations. Analysis of Holter registrations showed atrial fibrillation (AF) in two patients and atrioventricular (AV) block II in one patient (= 3.2% relevant arrhythmias [95% CI 1.1-8.9]). Intermittent handheld ECG detected nine patients with AF, three with paroxysmal supraventricular tachycardia (PSVT) and one with AV-block-II (= 13.7% relevant arrhythmias [95% CI 8.2-22.0]). There was a significant difference between the two methods in favour of intermittent ECG with regard to the ability to detect relevant arrhythmias (P = 0.0094). With Holter ECG, no symptoms were registered during any of the detected arrhythmias. With intermittent ECG, symptoms were registered during half of the arrhythmia episodes.

Conclusions: Intermittent short ECG recording during four weeks is more effective in detecting AF and PSVT in patients with ambiguous symptoms arousing suspicions of arrhythmia than 24-hour Holter ECG.

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Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Example of handheld ECG registration of AF and PSVT.
Figure 3
Figure 3
Time to detection (days) of relevant arrhythmias (AF, PSVT and AV-block II) with intermittent handheld ECG recording.
See this image and copyright information in PMC

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