24-hour Holter monitoring had a diagnostic yield up to 29% in nonagenarians, leading to therapeutic changes in 14% and urgent pacemaker implantation in 4%.
Does 24-hour Holter monitoring provide diagnostic value and change therapeutic management in nonagenarians?
24-hour Holter monitoring remains a valuable diagnostic tool in nonagenarians, particularly for evaluating syncope, palpitations, and stroke, leading to therapeutic changes in 14% of patients.
Absolute Event Rate: 0% vs 0%
Abstract Background With increasing life expectancy, the prevalence of very old individuals in clinical practice is rising. Despite this, there is a paucity of data regarding diagnostic performance of 24-hour Holter (24-H) monitoring in those patients (pts). Purpose To evaluate the diagnostic yield of 24-H monitoring in nonagenarians. Methods Single-center retrospective cohort study of pts with age ≥90yrs who underwent 24-H monitoring (Oct 2014-Nov 2022). Data on baseline characteristics, electrocardiography and outcomes (1-year all-cause mortality, cardiovascular (CV) mortality, urgent pacemaker (PM) implantation) was recorded. Regarding 24-H positive findings, it was defined: Sinus node disease (SND) (symptomatic sinus pause 2.5s; junctional rhythm); Atrioventricular (AV) node disease (type 2 2nd degree AV block; high-grade AV block; 3rd degree AV block); Atrial fibrillation (AF) (episode with duration 30s); Slow AF (mean ventricular rate 50/min; symptomatic ventricular pause 3s; asymptomatic ventricular pause 6s); Sustained (30s) supraventricular tachycardia; Ventricular tachycardia (sustained or symptomatic non-sustained). Statistical analysis was performed with SPSS v29. Results 204 exams from 181 pts were analyzed (median age 91yrs, 55% male). Structural heart disease was documented in 43% hypertensive heart disease (56%) and coronary artery disease (22%). Medication included beta-blockers (32%) and direct oral anticoagulants (25%). Electrocardiographic features: sinus rhythm (68%), bundle branch block (34%) and median corrected QT interval 435ms (IQR 390-480). Indications for Holter were: systematic stroke evaluation (40%-82 exams), syncope (17%-34 exams), monitoring of AF rate control (10%-21 exams), evaluation of asymptomatic bradycardia (8%-17 exams), monitoring of premature atrial/ventricular contractions (5%-10 exams), palpitations (3%-7 exams) and arrythmia risk stratification in cardiomyopathy (3%-7 exams). Positive findings were observed in 29% of syncope cases AV node disease (40%), SND (40%), and slow AF (20%) and 4pts (40%) were referred for PM implantation. Regarding palpitations, 2 pts had a positive study (29% diagnostic yield), 1 with AV node disease (referred for PM implantation) and 1 with de novo AF. Regarding stroke evaluation, the diagnostic yield was 26% (21/81 exams), the majority with de novo AF (76%). Of those 50% were anticoagulated. Overall, 24-H monitoring changed therapeutic attitudes in 26pts (14%). One-year all-cause mortality was 23%, 1-year CV mortality was 3% and 4% of pts required urgent PM implantation. Conclusion In this population, 24-H monitoring remained a valuable non-invasive test for nonagenarians, particularly in cases of syncope, palpitations and systematic stroke study and lead to changes in therapeutic management in 14% of pts. One-year mortality was high, mainly due to non-CV causes.Indication for 24H Holter 24H Holter positive findings
Vazao et al. (Sat,) reported a other. 24-hour Holter monitoring had a diagnostic yield up to 29% in nonagenarians, leading to therapeutic changes in 14% and urgent pacemaker implantation in 4%.
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