24-hour ambulatory electrocardiographic monitoring is unhelpful in the investigation of older persons with recurrent falls

BACKGROUND: Although frequently used in the assessment of patients with falls, it is unclear whether 24-hour ambulatory electrocardiography contributes to their assessment in older persons. OBJECTIVE: To identify electrocardiographic abnormalities in patients with recurrent falls and case controls, and determine whether 24-hour ambulatory electrocardiography identifies causal arrhythmias for falls. DESIGN: Prospective case-control study. METHODS: 24-hour ambulatory electrocardiography recordings were compared for the type and prevalence of arrhythmias and symptom correlation in consecutive older subjects with recurrent falls attending the accident and emergency department and in case controls (no previous falls or syncope). ECG abnormalities were categorised as major (ventricular arrhythmia, pauses, <30 b.p.m., Mobitz II, complete heart block) and minor (multiple ectopics, paroxysmal atrial arrhythmia and other bradyarrhythmias). RESULTS: 128 fallers (76 +/-6 years) and 100 case controls (75 +/-5 years) were recruited. Co-medication and co-morbidity were similar in both groups. 49% (63) of recordings in fallers and 41% (41) of recordings in controls were abnormal. There was no difference between groups in the prevalence of major or minor abnormalities or of symptoms during recording (breathlessness, fatigue, chest pain and dizziness). Palpitations occurred in 10% of fallers and 13% of controls. One patient fell during monitoring with no associated rhythm abnormality. CONCLUSION: Multiple abnormalities are present on 24-hour ambulatory electrocardiography in older people whether or not they have experienced falls. 24-hour electrocardiography does not discriminate between fallers and non-fallers and is not helpful in the investigation of recurrent falls.