title: Holter monitoring in syncope: diagnostic yield in octogenarians.
abstract: OBJECTIVE
  To determine the diagnostic yield of Holter monitoring in very old adults (≥80) with syncope.
  
  
  METHODS
  A Holter study was considered diagnostic if the arrhythmia explained syncope (atrioventricular (AV) block, sinus node dysfunction, atrial fibrillation with severe bradycardia or tachycardia, supraventricular or ventricular tachycardia).
  
  
  METHODS
  A tertiary care center in Switzerland over a period of 10 years.
  
  
  METHODS
  Four hundred seventy-five Holter studies were performed in individuals aged 80 and older (median age 84, 65% female, mean left ventricular ejection fraction (LVEF) 0.56 ± 0.1%).
  
  
  RESULTS
  Fifty-three Holter studies (11%) were diagnostic. The detected arrhythmias were AV block (n=13), sinus node dysfunction (n=13), binodal disease (n=2), atrial fibrillation with slow or rapid ventricular response (n=21), ventricular tachycardia (n=3) and supraventricular tachycardia (n=1). Forty participants (8%) received a pacemaker, and one received an implantable cardioverter-defibrillator because of the results of Holter monitoring. The yield of Holter monitoring was significantly greater (all P<.01) in the presence of heart disease (17%) and low LVEF (22%), in men (17%) and in participants aged 90 and older (20%). Heart disease (odds ratio (OR)=3.2, 95% confidence interval (CI)=1.7-6.1), male sex (OR=2.1, 95% CI=1.1-3.8), and aged 90 and older (OR=2.4, 95% CI=1.2-5.1) remained independent predictors for a high diagnostic yield of Holter monitoring. Furthermore, Holter monitoring was helpful in excluding arrhythmias as a cause of syncope in an additional 10% of cases.
  
  
  CONCLUSIONS
  The diagnostic value of Holter monitoring in participants aged 80 and older with syncope was 11.2%. Its yield was higher in men and in the presence of structural heart disease and was 20% in individuals aged 90 and older.
authors: From the Division of Cardiology, University of Basel Hospital, Basel, Switzerland. kuehnem@uhbs.ch
authors: Michael
authors: M
authors: Kühne
authors: Beat
authors: B
authors: Schaer
authors: Christian
authors: C
authors: Sticherling
authors: Stefan
authors: S
authors: Osswald
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000628:therapy; D001281:Atrial Fibrillation / Q000175:diagnosis; D054537:Atrioventricular Block / Q000175:diagnosis; D015716:Electrocardiography, Ambulatory; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012737:Sex Factors; D012804:Sick Sinus Syndrome / Q000175:diagnosis; D013575:Syncope / Q000209:etiology / Q000503:physiopathology*; D013617:Tachycardia, Supraventricular; D017180:Tachycardia, Ventricular / Q000175:diagnosis