title: 24-hour ambulatory electrocardiographic monitoring is unhelpful in the investigation of older persons with recurrent falls.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Falls and Syncope Service, Royal Victoria Infirmary, Newcastle-upon-Tyne NE1 4LP, UK. John.Davison@ncl.ac.uk
authors.forename: John
authors.initials: J
authors.lastname: Davison
authors.forename: Steven
authors.initials: S
authors.lastname: Brady
authors.forename: Rose Anne
authors.initials: RA
authors.lastname: Kenny
mesh_terms: D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D016022:Case-Control Studies; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence