Key result
48-hour Holter is linked to ~70% higher VT detection vs 24-hour monitoring in ischemic HF.
Why the study?
In patients with systolic heart failure and coexisting sleep apnea, the accuracy of 24-hour versus 48-hour ambulatory Holter ECG monitoring for detecting serious arrhythmia was uncertain.
Observational (n=84)
Absolute Event Rate: 40.5% vs 23.8%
p-value: p=0.0089
24-hour AECG may underestimate VT in systolic HF with apnea; leaves open whether extended monitoring improves risk stratification.
BACKGROUND: In patients with systolic heart failure (HF), coexisting sleep apnea may promote arrhythmia. Ambulatory Holter electrocardiogram (ECG) monitoring (AECG) is a method of arrhythmia and apnea evaluation. We hypothesized that 24-hour AECG in patients with HF who have a high risk of serious arrhythmia may be less accurate than AECG extended to 48 hours and that, moreover, arrhythmia may be related to apnea. METHODS: Eighty-four recordings of 48-hour AECG in 84 patients with ischemic HF (mean ejection fraction 34 ± 7%) were analyzed. Day 1, Day 2 were checked for ventricular tachycardia (VT) and supraventricular tachycardia (SVT). Estimated apnea-hypopnea index (est.AHI) was calculated using Holter, monitoring where est.AHI >15 indicates apnea. RESULTS: In 48-hour AECG, VT occurred in 34 patients (40.5%) whereas SVT in 17 patients (20.2%), and patients with est.AHI > 15 had higher VT occurrence. In two-sample one-sided test for proportions, 24-hour AECG from Day 1 showed a significantly lower percentage of patients with detected VT than 48-hour AECG-it was 23.8% (20 patients), meaning a significant underestimation with P = 0.0089. We assessed VT underestimation in the subgroups with regard to est.AHI, and found that it was present in Day 1 monitoring in the subgroups with est.AHI > 15. It was absent in the subgroups with est.AHI ≤ 15 and also in Day 2 monitoring. CONCLUSIONS: In patients with systolic HF, 24-hour AECG may have insufficient sensitivity regarding serious arrhythmia occurrence. If significant apnea was detected in the first day, extending the monitoring may be recommended.
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Uznańska‐Loch et al. (2012) conducted an observational in Ischemic heart failure (n=84). 48-hour ambulatory Holter ECG monitoring vs. 24-hour ambulatory Holter ECG monitoring was evaluated on Detection of ventricular tachycardia (VT) (p=0.0089). 48-hour ambulatory Holter ECG monitoring detected significantly more ventricular tachycardia than 24-hour monitoring in patients with ischemic heart failure (40.5% vs 23.8%; P=0.0089).
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