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QJM 2007 100(12):771-777; doi:10.1093/qjmed/hcm104
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© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Holter monitoring for syncope: diagnostic yield in different patient groups and impact on device implantation

M. Kühne*, B. Schaer*, N. Moulay, C. Sticherling and S. Osswald

From the Division of Cardiology, University Hospital Basel, Basel, Switzerland

Address correspondence to Dr B. Schaer, Division of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. email: bschaer{at}uhbs.ch

Received 21 May 2007 and in revised form 8 August 2007


  Abstract

Background: Holter monitoring is routinely used in patients referred for the evaluation of syncope, but its diagnostic value in different patient groups is unclear, as is its impact on device implantation (pacemaker or cardioverter-defibrillator).

Aim: To determine the diagnostic yield of Holter monitoring in the routine evaluation of syncope, and its impact on subsequent device implantation.

Design: Retrospective record review.

Methods: We reviewed all Holter studies in patients referred with syncope between 2000 and 2005. Strict criteria were applied to determine whether a study was diagnostic. The diagnostic value of Holter monitoring (overall and in five subgroups: age, gender, structural heart disease, ejection fraction, medication) and its impact on the implantation of devices, were determined.

Results: Of 4877 Holter studies, 826 were performed in patients with syncope (age 72 ± 15 years): 71 (8.6%) were considered to explain the syncope. Structural heart disease, ejection fraction and age were significant predictors of a diagnostic study (all p < 0.01), whereas gender and cardiac medication were not. A device was implanted in 33 patients (4.4%) whose initial Holter did not explain their syncope, after mean 7 months, whereas 45 patients (5.4%) received a pacemaker based on the Holter results (p = 0.32).

Discussion: The overall diagnostic yield of Holter monitoring in the evaluation of syncope was 8.6%, with dramatic differences between subgroups. Our data suggest that the impact of Holter monitoring on device implantation is generally overestimated.

*These authors contributed equally to this paper.


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