title: Predictors of arrhythmic events during second day monitoring in patients with normal first day Holter recordings.
abstract: BACKGROUND
  The diagnostic yield of Holter monitoring in patients with syncope is variably reported to be between 6%-20%. This study was done to define predictors of arrhythmic events during the second day of Holter monitoring in patients whose first day Holter recording was normal.
  
  
  RESULTS
  Two serial 24-hour Holter recordings were obtained in a consecutive series of 100 patients (49 patients with unexplained syncope and/or pre-syncope and 51 patients with palpitation). The age of patients was 53.4 +/- 16.9 years and 51 were men. Seventy-six patients had underlying heart disease. Main electrocardiographic findings were found in 40 (40%) patients including non-sustained ventricular tachycardia in 19, sinus pause in 13, symptomatic bradycardia in 5, paroxysmal atrial fibrillation in 4, sustained supraventricular tachycardia in 2, and Mobitz type II second-degree atrioventricular block in 3 patients. Twenty-seven (27%) patients had 33 main electrocardiographic findings during the first day and 13 out of the remaining 73 patients (17.8%) had it during the second day of Holter recording. Presenting symptom (syncope/pre-syncope), age > 65 years, and male gender were significantly associated with increased likelihood of main electrocardiographic findings during the second day of Holter monitoring (p = 006, 0.023, and 0.024, respectively). The risk of main electrocardiographic findings ranged from 5% in patients with one or no predictor to 35% in those with > or = 2 predictors (OR = 9.95, 95% CI = 2.01-49.2, p = 0.002).
  
  
  CONCLUSIONS
  Presenting symptom (syncope/pre-syncope), age > 65 years, and male gender increased the likelihood of main electrocardiographic findings during the second day of Holter monitoring.
authors.affiliation: Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. dr.arasharya@gmail.com
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.forename: Majid
authors.initials: M
authors.lastname: Haghjoo
authors.forename: Arezoo
authors.initials: A
authors.lastname: Khosrawi
authors.forename: Zahra
authors.initials: Z
authors.lastname: Emkanjoo
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Sadr-Ameli
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D016001:Confidence Intervals; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D013575:Syncope / Q000175:diagnosis* / Q000453:epidemiology; D013997:Time Factors