Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmiasReport as inadecuate

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BMC Cardiovascular Disorders

, 14:41

Non-coronary artery cardiac disease


BackgroundMany patients report symptoms of palpitations or dizziness-presyncope. These patients are often referred for 24-hour Holter ECG, although the sensitivity for detecting relevant arrhythmias is comparatively low. Intermittent short ECG recording over a longer time period might be a convenient and more sensitive alternative. The objective of this study is to compare the efficacy of 24-hour Holter ECG with intermittent short ECG recording over four weeks to detect relevant arrhythmias in patients with palpitations or dizziness-presyncope.

MethodsDesign: prospective, observational, cross-sectional study. Setting: Clinical Physiology, University Hospital. Patients: 108 consecutive patients referred for ambiguous palpitations or dizziness-presyncope. Interventions: All individuals underwent a 24-hour Holter ECG and additionally registered 30-second handheld ECG Zenicor EKG® thumb recordings at home, twice daily and when having cardiac symptoms, during 28 days. Main outcome measures: Significant arrhythmias: atrial fibrillation AF, paroxysmal supraventricular tachycardia PSVT, atrioventricular AV block II–III, sinus arrest SA, wide complex tachycardia WCT.

Results95 patients, 42 men and 53 women with a mean age of 54.1 years, completed registrations. Analysis of Holter registrations showed atrial fibrillation AF in two patients and atrioventricular AV block II in one patient = 3.2% relevant arrhythmias 95% CI 1.1–8.9. Intermittent handheld ECG detected nine patients with AF, three with paroxysmal supraventricular tachycardia PSVT and one with AV-block-II = 13.7% relevant arrhythmias 95% CI 8.2–22.0. There was a significant difference between the two methods in favour of intermittent ECG with regard to the ability to detect relevant arrhythmias P = 0.0094. With Holter ECG, no symptoms were registered during any of the detected arrhythmias. With intermittent ECG, symptoms were registered during half of the arrhythmia episodes.

ConclusionsIntermittent short ECG recording during four weeks is more effective in detecting AF and PSVT in patients with ambiguous symptoms arousing suspicions of arrhythmia than 24-hour Holter ECG.

KeywordsArrhythmias Atrial fibrillation Electrocardiography Holter ECG Intermittent ECG AbbreviationsAFAtrial fibrillation


CIConfidence interval


PSVTParoxysmal supraventricular tachycardia


WCTWide complex tachycardia


Electronic supplementary materialThe online version of this article doi:10.1186-1471-2261-14-41 contains supplementary material, which is available to authorized users.

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Author: Tijn Hendrikx - Mårten Rosenqvist - Per Wester - Herbert Sandström - Rolf Hörnsten


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