Holter monitoring for syncope: diagnostic yield in different patient groups and impact on device implantation
1Division of Cardiology, University Hospital Basel, Petersgraben 4, Basel, Switzerland.
Insights
Holter monitoring yields a diagnosis in only 8.6% of syncope evaluations, with significant variations across patient groups. Its impact on pacemaker or cardioverter-defibrillator implantation is often overestimated.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Holter monitoring is standard for syncope evaluation.
- Its diagnostic utility and effect on device implantation remain unclear across patient demographics.
Purpose of the Study:
- To assess the diagnostic yield of Holter monitoring in syncope patients.
- To determine its influence on pacemaker and cardioverter-defibrillator implantation.
Main Methods:
- Retrospective review of 826 Holter studies in syncope patients (2000-2005).
- Analysis of diagnostic yield based on strict criteria.
- Evaluation of impact on device implantation.
Main Results:
- Overall diagnostic yield was 8.6% (71/826 studies).
- Age, ejection fraction, and structural heart disease predicted diagnostic studies (p < 0.01).
- Device implantation occurred in 4.4% without initial diagnosis and 5.4% based on Holter results.
Conclusions:
- Holter monitoring has a low diagnostic yield for syncope (8.6%), varying significantly by patient subgroup.
- The influence of Holter monitoring on device implantation decisions is frequently overestimated.
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.
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