An old diagnostic tool for new indications: inpatient Holter ECG for conditions other than syncope or stroke

Area of Science:

• Cardiology
• Internal Medicine
• Diagnostic Tools

Background:

• Holter electrocardiography (ECG) is crucial for diagnosing arrhythmias.
• Current inpatient use is limited to stroke and syncope evaluations.
• Its utility in broader internal medicine settings is under-explored.

Purpose of the Study:

• To evaluate the diagnostic value of inpatient Holter ECG for internal medicine patients with conditions other than stroke or syncope.
• To identify patient groups and clinical factors associated with diagnostic Holter findings.

Main Methods:

• Retrospective analysis of 289 hospitalized patients undergoing 24-h Holter ECG (2018-2021).
• Primary outcome: diagnostic Holter recording leading to treatment change.
• Identified independent predictors for diagnostic yield.

Main Results:

• Overall diagnostic yield was 13% (39/289) for non-stroke/syncope indications.
• Highest diagnostic yield observed in pre-syncope (19%), palpitations (18%), and heart failure exacerbation (17%).
• Low yield for chest pain (5%); predictors included heart failure with preserved ejection fraction and baseline ECG abnormalities (bundle branch block, AV block).

Conclusions:

• Inpatient Holter ECG offers diagnostic value for selected internal medicine patients.
• Consider Holter monitoring for pre-syncope, palpitations, and unexplained dyspnea/heart failure exacerbation.
• Baseline ECG findings can help predict diagnostic Holter utility.