Holter monitoring in syncope: diagnostic yield in octogenarians

Objectives: To determine the diagnostic yield of Holter monitoring in very old adults (≥80) with syncope.

Design: A Holter study was considered diagnostic if the arrhythmia explained syncope (atrioventricular (AV) block, sinus node dysfunction, atrial fibrillation with severe bradycardia or tachycardia, supraventricular or ventricular tachycardia).

Setting: A tertiary care center in Switzerland over a period of 10 years.

Participants: Four hundred seventy-five Holter studies were performed in individuals aged 80 and older (median age 84, 65% female, mean left ventricular ejection fraction (LVEF) 0.56 ± 0.1%).

Measurements and results: Fifty-three Holter studies (11%) were diagnostic. The detected arrhythmias were AV block (n=13), sinus node dysfunction (n=13), binodal disease (n=2), atrial fibrillation with slow or rapid ventricular response (n=21), ventricular tachycardia (n=3) and supraventricular tachycardia (n=1). Forty participants (8%) received a pacemaker, and one received an implantable cardioverter-defibrillator because of the results of Holter monitoring. The yield of Holter monitoring was significantly greater (all P<.01) in the presence of heart disease (17%) and low LVEF (22%), in men (17%) and in participants aged 90 and older (20%). Heart disease (odds ratio (OR)=3.2, 95% confidence interval (CI)=1.7-6.1), male sex (OR=2.1, 95% CI=1.1-3.8), and aged 90 and older (OR=2.4, 95% CI=1.2-5.1) remained independent predictors for a high diagnostic yield of Holter monitoring. Furthermore, Holter monitoring was helpful in excluding arrhythmias as a cause of syncope in an additional 10% of cases.

Conclusion: The diagnostic value of Holter monitoring in participants aged 80 and older with syncope was 11.2%. Its yield was higher in men and in the presence of structural heart disease and was 20% in individuals aged 90 and older.