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Holter Monitor: 24-Hour Monitoring
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Holter Monitor: 24-Hour Monitoring

Published on: June 19, 2025

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Risk stratification for cardiac mortality using electrocardiographic markers based on 24-hour Holter recordings: the

Toshio Kinoshita1, Kenichi Hashimoto2, Koichiro Yoshioka3

  • 1Toho University, Tokyo, Japan.

Journal of Cardiology
|September 3, 2019
PubMed

Insights

Nonsustained ventricular tachycardia (NSVT) and abnormal heart rate turbulence (HRT) on 24-hour ECG are valuable predictors of mortality and serious arrhythmias in patients with structural heart disease (SHD). Combined assessment of these electrocardiographic markers improves predictive accuracy for adverse cardiac events.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Preventive Medicine

Background:

  • Left ventricular ejection fraction (LVEF) is the current standard for assessing cardiac mortality risk.
  • Limited information exists on electrocardiographic (ECG) markers for predicting adverse outcomes in patients with structural heart disease (SHD).

Purpose of the Study:

  • To evaluate the efficacy of specific ECG markers in predicting mortality and serious arrhythmias in patients with SHD.
  • To identify novel ECG-based predictors that complement existing risk stratification methods like LVEF.

Main Methods:

  • Analysis of data from 719 patients with SHD in the Japanese Multicenter Observational Prospective Study (JANIES).
  • Assessment of 24-hour Holter ECG recordings for nonsustained ventricular tachycardia (NSVT), ventricular late potentials, and heart rate turbulence (HRT).
  • Primary endpoint: all-cause mortality; Secondary endpoint: fatal arrhythmic events.

Main Results:

  • During a mean follow-up of 21 months, 5.4% of patients experienced all-cause mortality, with 82% due to cardiac causes.
  • Multivariate analysis revealed that documented NSVT (HR=2.46) and abnormal HRT (HR=2.40) were significant predictors of mortality, independent of age and LVEF.
  • Both NSVT and HRT demonstrated significant predictive value for fatal arrhythmic events, with combined assessment enhancing predictive accuracy.

Conclusions:

  • Documented NSVT and abnormal HRT identified via 24-hour Holter ECG are recommended for predicting serious future events in SHD patients.
  • The combined assessment of these ECG markers offers improved predictive accuracy for adverse cardiac outcomes.
  • These ECG markers provide valuable insights for risk stratification beyond traditional measures like LVEF.
Abstract

Keywords:
Electrocardiographic markerHeart rate turbulenceNonsustained ventricular tachycardiaRisk stratificationStructural heart disease

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