Key result
24-hour Holter monitoring detects isolated ventricular ectopics in ~39% of symptomatic patients.
Why the study?
Cardiac arrhythmias contribute significantly to morbidity and mortality, prompting this study to determine the distribution and spectrum of arrhythmias detected on 24-hour Holter recordings in symptomatic patients.
In symptomatic patients undergoing 24-hour Holter monitoring, benign ectopic activities predominated, while clinically significant bradyarrhythmias and conduction disease were less frequent.
Benign ectopy rarely requires intervention in symptomatic patients; leaves open prognostic implications beyond this tertiary center.
Introduction: Cardiac arrhythmia, a significant contributor to morbidity and mortality, may present with non-specific symptoms, including palpitations, dizziness, presyncope, or syncope. Holter monitoring is widely used to detect intermittent cardiac arrhythmias in symptomatic patients. This study was conducted to determine the distribution and spectrum of arrhythmias detected on 24-hour Holter recordings in symptomatic patients in a tertiary-level hospital. Methods: A retrospective observational study was conducted among 153 patients who underwent 24-hour Holter monitoring at Shree Birendra Hospital, Kathmandu, Nepal, from January to December 2023. Recordings were analyzed with Medilog Darwin 2 software and confirmed by cardiologists. Arrhythmias were classified using standard definitions; ventricular ectopics were categorized as isolated beats or runs (≥3 consecutive ventricular beats). Data were analyzed using SPSS v22. Results: Isolated ventricular ectopics and runs of ventricular ectopics were present in 59 (38.56%) and 32 (20.91%) patients, respectively. Supraventricular ectopics and atrial fibrillation occurred in 26 (16.99%) and 20 (13.07%) patients, respectively. Similarly, sinus tachycardia and sinus bradycardia were reported in 32 (20.91%) and 18 (11.76%) patients. High-grade atrioventricular block was observed in 7 (4.57%) and pauses ≥2 seconds in 5 (3.26%) cases. Conclusions: The benign ectopic activities, such as VES, SVES predominated while clinically significant bradyarrhythmias and conduction disease were less frequent in this study. The identification of conduction abnormalities underscores the role of Holter monitoring in detecting intermittent rhythm disorders that may not be captured on resting ECG.
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Thapa et al. (2026) studied this question. Isolated ventricular ectopics occurred in 38.56% and atrial fibrillation in 13.07% of symptomatic patients on 24-hour Holter monitoring in a Nepal tertiary center.
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