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Arrhythmias in ambulatory persons. A review and experience of 1,000 consecutive recordings
Insights
24-hour ambulatory ECG monitoring, also known as dynamic electrocardiogram (DCG), is valuable for diagnosing dizziness, palpitations, and syncope. This study found it provided useful diagnostic information in 65% of recordings and 74% of patients.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- The diagnostic utility of 24-hour ambulatory ECG monitoring for symptoms like dizziness, palpitations, and syncope remains debated.
- A hospital-based clinical service's data was analyzed to assess the value of this diagnostic tool.
Purpose of the Study:
- To evaluate the diagnostic yield of 24-hour ambulatory ECG monitoring (dynamic electrocardiogram, DCG) in a clinical setting.
- To determine the percentage of patients and recordings that yielded useful diagnostic information.
Main Methods:
- 1,000 consecutive dynamic electrocardiograms (DCGs) were reviewed, with 678 performed for dizziness, syncope, or palpitations in 405 patients.
- Recordings were categorized based on the correlation between DCG findings (significant arrhythmias, SA) and patient diary symptoms.
- Inadequate recordings and patients with pacemakers were noted.
Main Results:
- 65% of recordings and 74% of patients received useful diagnostic information.
- Completely diagnostic recordings (SA correlating with symptoms) were 99.
- Incompletely diagnostic categories were clinically valuable, either excluding arrhythmias or identifying unrelated arrhythmias, contributing to diagnosis.
Conclusions:
- 24-hour ambulatory ECG monitoring is a clinically valuable tool for diagnosing cardiac-related symptoms.
- The service provided useful diagnostic information in a significant majority of patients and recordings evaluated.
- Careful interpretation considering patient diaries and potential for non-cardiac causes is essential.
Abstract:
The value of 24-hour ambulatory monitoring of the ECG for the diagnosis of symptoms of dizziness, palpitations and syncope is controversial. In this study results from a hospital-based, clinical service have been analysed. Of 1,000 consecutive dynamic electrocardiograms (DCG), 678 were performed for assessment of dizziness, syncope or palpitations in 405 patients. 36 of the patients had pacemakers. 60 DCGs were technically inadequate. The recordings were classified according to the correspondence between DCG findings and symptoms noted in the patient diary: (I) Completely diagnostic: significant arrhythmias (SA) corresponding to diary symptoms - 99 recordings. (II) Incompletely diagnostic: (a) absence of SA in the presence of diary symptoms - 90 recordings; (b) presence of SA but no diary symptoms - 197 recordings; (c) presence of SA corresponding to symptoms other than that for which the DCG was indicated - 52 recordings. (III) Non-diagnostic: absence of both SA and diary symptoms - 180 recordings. Incompletely diagnostic categories were regarded as clinically valuable in that they either excluded a cardiac arrhythmia as a cause of symptoms (group IIa) or they revealed SA which did not correspond to diary symptoms (group IIc). The absence of symptoms corresponding to SA was ascribed to poor diary keeping in 54 of 197 recordings. These results are discussed in the context of the findings in normal and symptomatic patients. A clinical 24-hour ambulatory ECG monitoring service provided useful diagnostic information in 65% of recordings and 74% of patients.