Why the study?
Holter monitoring is often preferred for frequent symptoms despite limited evidence linking symptom frequency to optimal monitoring duration, while long-term continuous monitoring yields more arrhythmia diagnoses.
Does symptom frequency affect arrhythmia detection yield and time to detection in patients undergoing long-term continuous monitoring?
Does symptom frequency affect arrhythmia detection yield and time to detection in patients undergoing long-term continuous monitoring?
Long-term continuous monitoring (up to 14 days) is necessary to detect actionable arrhythmias regardless of symptom frequency, as most arrhythmias occur after 48 hours, suggesting standard Holter monitoring may miss clinically meaningful events even in highly symptomatic patients.
Answers are grounded in this paper and cite their sources.
Symptom frequency does not affect arrhythmia yield on continuous monitoring; leaves open optimal duration for detection regardless of symptoms.
BACKGROUND: Arrhythmias are challenging to detect owing to their intermittent nature and variability in symptom reporting. Although long-term continuous monitoring (≤14 days) yields more diagnoses than short-term (Holter) monitoring (≤48 hours), Holter is often preferred by clinicians and payors for frequent symptoms despite limited evidence linking symptom frequency to optimal monitoring duration. OBJECTIVE: This study aimed to assess the relationship between symptom frequency and arrhythmia detection in long-term continuous monitoring patients. METHODS: We performed a retrospective cohort study of adults aged ≥18 years with uninterrupted, patch-based long-term continuous monitoring (≤14 days) with push-button symptom annotation between June 2023 and July 2024. Symptom frequency was defined by device button presses: daily (≥1/d) or nondaily (<1/d). Outcomes included arrhythmia yield, time to first arrhythmia, and symptom-rhythm correlation. RESULTS: Among 1,100,337 devices, 20.8% of patients had daily symptoms and the actionable arrhythmia yield was 35.8%. Most arrhythmias occurred after 48 hours (daily 64.0%; nondaily 59.9%). The median time to detection was >48 hours for daily (3.52 days [Q1-Q3 0.94-7.45]) and nondaily symptoms (3.00 [0.72-6.97]). Adjusted odds of arrhythmia yield did not differ by symptom frequency (adjusted odds ratio 1.00; 95% confidence interval 0.98-1.02). Symptom-rhythm correlation was 18.3% overall and highest for atrial fibrillation and isolated ectopic beats (>30%), but <15% for other rhythms. Patients with nondaily symptoms had lower odds of symptom-rhythm correlation (adjusted odds ratio 0.226; 95% confidence interval 0.223-0.229). CONCLUSION: Symptom-rhythm correlation varied by arrhythmia type and symptom frequency. The median time to actionable arrhythmia was >48 hours, regardless of symptom frequency. Holter may miss clinically meaningful events, even in patients with daily symptoms.
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Battisti et al. (2025) studied this question.
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