title: Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmias.
abstract: BACKGROUND
  Many patients report symptoms of palpitations or dizziness/presyncope. These patients are often referred for 24-hour Holter ECG, although the sensitivity for detecting relevant arrhythmias is comparatively low. Intermittent short ECG recording over a longer time period might be a convenient and more sensitive alternative. The objective of this study is to compare the efficacy of 24-hour Holter ECG with intermittent short ECG recording over four weeks to detect relevant arrhythmias in patients with palpitations or dizziness/presyncope.
  
  
  METHODS
  
  
  
  METHODS
  prospective, observational, cross-sectional study.
  
  
  METHODS
  Clinical Physiology, University Hospital.
  
  
  METHODS
  108 consecutive patients referred for ambiguous palpitations or dizziness/presyncope.
  
  
  METHODS
  All individuals underwent a 24-hour Holter ECG and additionally registered 30-second handheld ECG (Zenicor EKG® thumb) recordings at home, twice daily and when having cardiac symptoms, during 28 days.
  
  
  METHODS
  Significant arrhythmias: atrial fibrillation (AF), paroxysmal supraventricular tachycardia (PSVT), atrioventricular (AV) block II-III, sinus arrest (SA), wide complex tachycardia (WCT).
  
  
  RESULTS
  95 patients, 42 men and 53 women with a mean age of 54.1 years, completed registrations. Analysis of Holter registrations showed atrial fibrillation (AF) in two patients and atrioventricular (AV) block II in one patient (= 3.2% relevant arrhythmias [95% CI 1.1-8.9]). Intermittent handheld ECG detected nine patients with AF, three with paroxysmal supraventricular tachycardia (PSVT) and one with AV-block-II (= 13.7% relevant arrhythmias [95% CI 8.2-22.0]). There was a significant difference between the two methods in favour of intermittent ECG with regard to the ability to detect relevant arrhythmias (P = 0.0094). With Holter ECG, no symptoms were registered during any of the detected arrhythmias. With intermittent ECG, symptoms were registered during half of the arrhythmia episodes.
  
  
  CONCLUSIONS
  Intermittent short ECG recording during four weeks is more effective in detecting AF and PSVT in patients with ambiguous symptoms arousing suspicions of arrhythmia than 24-hour Holter ECG.
authors.affiliation: Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87 Umeå, Sweden. tijn.hendrikx@fammed.umu.se.
authors.forename: Tijn
authors.initials: T
authors.lastname: Hendrikx
authors.forename: Mårten
authors.initials: M
authors.lastname: Rosenqvist
authors.forename: Per
authors.initials: P
authors.lastname: Wester
authors.forename: Herbert
authors.initials: H
authors.lastname: Sandström
authors.forename: Rolf
authors.initials: R
authors.lastname: Hörnsten
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology; D054537:Atrioventricular Block / Q000175:diagnosis / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004562:Electrocardiography / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013548:Sweden; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000503:physiopathology; D013997:Time Factors; D055815:Young Adult